Professional 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: Angiotensin II Receptor Blockers
Function? Reduces BP by inhibiting effects of AT II
Example? Losartan
SE? Dizziness, Headache, Hyperkalaemia
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 mannitol -> osmotic diuresis -> v ICP
Loop NKCC2 furosemide, bumetanide
DCT NCC bendroflumethiazide
C.duct ENaC amiloride/spironolactone -> K+ sparing
Pharmacology - Angina
Nitrates
What? Generates NO
Function? Cause Vasodilatation = v PVR -> vBP
Example? Glyceryl Trinitrate (GTN) spray
SE? Postural Hypotension, Headaches
Myocardial Infarction
MORPHINE Pain relief, some vasodilatation
OXYGEN ^O2 to ischaemic tissues
NITRATES Vasodilatation
ASPIRIN COX1 inhibitor, x platelet aggregation
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? HMG CoA Reductase Inhibitor
Example? Simvastatin
SE? Rhabdomyolysis
->Muscles break down
->Haematuria
Pharmacology - AF
What: Atrial Tachyarrythmia, common
Rapid irregularly irregular pulse
Ix: ECG
CHA2DS2-VASc
SCORE
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: Reversible bronchoconstriction due to
inflammation in hyperactive airways.
Type 1 HS
INFLAMMATION
Pharmacology – Asthma
Tx: Poor control:
LABA (Salmetarol)
Leukotriene Receptor Antagonist (Montelukast)
Oral Steroids
LAMA (Ipratropium Bromide = Atrovent)
Myasthenia Gravis
Parkinson’s Disease
Huntington’s Disease
Alzheimer’s Disease
Headaches
Pharmacology - Epilepsy
What: Spontaneously recurring seizures other
than febrile convulsions without metabolic
abnormality or acute cerebral insult.
A seizure is a clinical event due to abnormal XS
neuronal DC leading to a sudden disturbance of
neurological function
IDIOPATHIC 1o GENERALISED
1. Childhood absence -> petit mal
2. 1o generalised tonic-clonic -> grand mal on waking
3. Juvenile myclonic epilepsy -> morning clumsiness
Tx: Sodium Valproate
Pharmacology - Epilepsy
Carbamazepine
Function: Inhibits sodium channels
SE: Drowsiness, ataxia, dizzy, vNa, Neutropenia
Sodium Valproate
Function: Inhibits Na/Ca channels, ^GABA -> inhibitory
SE: Teratogenic, hepatotoxic
Lamotrigine
Function: Inhibits Na/Ca channels
SE: Steven-Johnson Syndrome
Pharmacology - MG
What: Autoimmune disease with AChR antibodies,
inhibit action of Ach on postsynaptic membrane
PC: Fatiguable muscle weakness, N reflexes
Ix: Tensilon Test (edrophonium), Antibody screen
Tx: Acetylcholinesterase Inhibitor – Pyridostigmine
Stops breakdown of ACh so around longer to
stimulate receptor
Pharmacology – Alzheimer’s
What: Loss of cholinergic neurons in nuclei
Neurofibrillary tangles with tau protein
Tx: Cholinesterase Inhibitors to ^ Ach
e.g. Donepezil, Rivastigmine
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)
RITUXIMAB
What? Anti-CD20 monoclonal antibody -> B cell cytopenia
+MTX in severe RA if no response MTX/anti-TNF
Pharmacology - Endocrine
Acromegaly
Thyroid
Conn’s Syndrome
Hypokalaemia
Hyperkalaemia
Pharmacology - Acromegaly
What: Excessive growth hormone after fusion of epiphyses
(growth plates)
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 – Conn’s
What: Primary Hyperaldosteronism
PC: Asymptomatic
Generalised weakness, muscle pain, constipation
Muscle weakness/paralysis, resp failure, ileus
Pharmacology - HypoK
Ix: Bloods -> U&Es vK+, vNa+ (diuretics), Mg2+, Glucose
ECG
Rods Cocci
Clostridium, Listeria Staph, Strep
E.coli, Salmonella, Neisseria
Shigella, Pseudomonas
Helicobacter
Microbiology
GRAM + COCCI
Chains? Clusters?
Streptococcus Staphylococcus
Blood agar? Coagulase/DNAse?
Yes No
Escherichia Coli 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: Infection with Mycobacterium Tuberculosis/
Mycobacterium Bovis.
Macrophages + lymphocytes
Bacilli settle seal in and contain and kill
in lung Apex Infecting bacilli
The Lungs
Pulmonary TB
Bacilli taken in
lymphatics
to hilar lymph
nodes
The Lungs
Miliary TB
Bacilli settle
in lung Apex
Bacilli taken
to hilar lymph
nodes Pleural TB
The Lungs
Bone and Joint TB
Genito urinary TB
TB
PC: General MSK Tb
Weight loss Pott’s Disease
Night sweats Septic Arthritis
Lethargy
Abdominal TB
Pulmonary TB Peritonitis
Haemoptysis Ascites
Chest pain
Chronic dry cough Genitourinary TB
Dysuria
TB Meningitis Sterile Pyuria
TB
Ix: Sputum culture x 3 Ziehl Neelson/
Lowenstein-Jenson stain
CXR
Mantoux test Latent/vaccination
Quantiferon
TB
Tx: Rifampicin (6/12) – red/orange urine
Isoniazide (6/12) – Hepatitis (severe)
Pyrazinimide (2/12) – Hepatitis (common)
Ethambutol (2/12) – Ocular toxicity
Hypnozoites
RELAPSE
Malaria
Who: Pregnancy, kids, foreign travelers, HIV
Tx: Supportive
Prevent hepatic failure
Hepatitis Serology
Core Antigen cAg = ACUTE ^^^ Virus replication
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: Cellulitis
Bug: Staphylococcus Aureus/Epidermidis
Ix: Blood cultures, wound swab
Tx: 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
H. Influenzae
Strep.Pneumoniae
Ix: LP, Bloods, blood cultures, ABG, ECG
Tx: 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: ?
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: ?
Ix: ?
Bug: ?
Tx: ?
Quiz
Andy’s 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%