p.12
Anaesthesia Considerations for Epileptic Patients
What should be done with lithium before surgery?
Lithium should be discontinued 72 hours prior to surgery, except for minor surgery under local anaesthesia.
p.19
Anticonvulsant Medications
What are the common uses of Diazepam?
Tonic-clonic seizures, status epilepticus, anxiolysis, alcohol withdrawal, muscle spasm, sedation, and premedication.
p.6
Anticonvulsant Medications
What are the available forms of sodium valproate?
Tablets (100/200/500 mg), syrup (40 mg/mL), and powder (400 mg ampoules for dissolution in water).
What is the typical dose of Flumazenil?
100 μg boluses, titrated to effect, with a maximum of 1 mg.
p.3
Classification of Epilepsy
What is epilepsy?
A chronic disease resulting from paroxysmal, episodic, abnormal and spontaneous discharge of electrical activity in the brain.
What is the primary use of Flumazenil?
To reverse the effects of benzodiazepines, especially in cases of overdose.
p.15
Anaesthesia Considerations for Epileptic Patients
What caution should be taken with thiopentone in asthma patients?
It may cause histamine release.
p.3
Classification of Epilepsy
How is epilepsy classified?
It is classified into generalized and partial (focal) seizures.
p.4
Anticonvulsant Medications
How do barbiturates like phenobarbitone work?
They increase the duration of opening of the GABA-A chloride channel when stimulated.
p.17
Anticonvulsant Medications
What is the primary classification of Aminophylline?
Methylxanthine derivative.
What is the duration of action for Flumazenil?
It lasts between 15 minutes to 2 hours.
p.12
Antidepressant Classes and Mechanisms
What is serotonin syndrome?
A potentially life-threatening adverse drug reaction resulting from increased levels of serotonin in the brain stem and spinal cord.
p.15
Anaesthesia Considerations for Epileptic Patients
What is required for the delivery of inhalational volatile anaesthetics?
An anaesthetic machine, although it may be administered through in-line devices in certain critical care ventilators.
p.7
Anticonvulsant Medications
What forms of carbamazepine are available?
Tablets (100/200/400 mg), suppositories (125/250 mg), and syrup (20 mg/mL).
p.13
Pharmacological Management of Asthma
What characterizes asthma?
Reversible airway obstruction secondary to bronchoconstriction.
p.10
Antidepressant Classes and Mechanisms
What is a significant risk associated with TCA overdose?
Severe symptoms may occur within 1 hour due to a narrow therapeutic index.
p.12
Anaesthesia Considerations for Epileptic Patients
What cardiovascular monitoring is necessary for patients with serotonin syndrome?
ECG monitoring due to the risk of various cardiovascular abnormalities.
p.3
Classification of Epilepsy
What characterizes complex partial seizures?
Consciousness is impaired, confined to one brain region, and may involve automatisms.
p.10
Antidepressant Classes and Mechanisms
What is the initial treatment for symptomatic TCA overdose?
Continuous monitoring of blood pressure, ECG, CNS, and arterial pH, with ventilatory support if needed.
p.5
Anticonvulsant Medications
What is the primary class of Phenytoin?
Anticonvulsant and Class 1b antiarrhythmic.
p.7
Anticonvulsant Medications
What is the primary use of carbamazepine?
Treatment of epilepsy, especially generalized seizures and infantile spasms.
p.4
Anticonvulsant Medications
What are the two types of benzodiazepine receptors and their effects?
BDZ1 causes anxiolysis and is found in the spinal cord and cerebellum; BDZ2 causes sedation and has an anticonvulsant effect, found in the spinal cord, hippocampus, and cerebral cortex.
p.20
Anaesthesia Considerations for Epileptic Patients
What are the available forms of Midazolam?
Oral, nasal, PR, IM, IV, intrathecally, and epidural.
p.19
Anticonvulsant Medications
What is the typical IV dose range for Diazepam for sedation?
5–20 mg, titrated to effect.
p.12
Anaesthesia Considerations for Epileptic Patients
What monitoring is advised for patients on lithium during anaesthesia?
Neuromuscular monitoring due to prolonged neuromuscular blockade.
p.17
Anticonvulsant Medications
What is the significance of zero order kinetics in Aminophylline?
It occurs at plasma levels greater than 35 μg/kg.
p.23
Pharmacological Management of Asthma
What are the main uses of Phenylephrine?
To increase SVR and as a nasal decongestant.
p.2
Management of Type 2 Diabetes Mellitus
When were the NICE guidelines on the management of type 2 diabetes mellitus first published and updated?
First published in 2009 and updated in 2014.
p.8
Antidepressant Classes and Mechanisms
What are the side effects of MAOIs?
Hypertension, serotonin syndrome, orthostatic hypotension, psychosis, headaches, insomnia, sexual dysfunction, weight gain.
p.8
Anaesthesia Considerations for Epileptic Patients
What should be done pre-operatively for patients on MAOIs?
Treatment should be gradually discontinued, and if continued, benzodiazepine premedication should be used.
p.9
Anaesthesia Considerations for Epileptic Patients
Why should pancuronium be avoided in anaesthesia?
It can cause noradrenaline release.
p.15
Anaesthesia Considerations for Epileptic Patients
What are essential requirements when using volatile agents?
Gas analysis and scavenging.
p.4
Anticonvulsant Medications
What is the primary mechanism of action for benzodiazepines?
They facilitate the binding of GABA to its respective receptor and increase the frequency of opening of GABA-A channels.
p.17
Anticonvulsant Medications
What are the available forms of Aminophylline?
Tablets (100/225/350 mg), suppositories (180/360 mg), and clear colourless solution (25 mg/mL).
p.8
Antidepressant Classes and Mechanisms
How do antidepressants work?
By altering the balance of central neurotransmitters.
p.3
Classification of Epilepsy
What are generalized seizures?
Seizures that involve both cerebral hemispheres and impair consciousness.
How quickly does Flumazenil work after administration?
It works within 1 minute.
p.12
Antidepressant Classes and Mechanisms
What are the clinical features of serotonin syndrome?
Changes in behavior, increased motor activity, autonomic instability, seizures, rhabdomyolysis, renal failure, arrhythmias, coma, and death.
p.15
Anaesthesia Considerations for Epileptic Patients
Why should atracurium be avoided in asthma patients?
It causes histamine release.
p.2
Management of Type 2 Diabetes Mellitus
What are the first-line treatments for type 2 diabetes mellitus according to NICE guidelines?
Metformin for overweight and non-overweight patients, sulphonylurea for non-overweight patients or those who cannot take metformin, rapid-acting secretagogues (meglitinides) for people with erratic lifestyles, and acarbose if the above are not tolerated.
p.4
Anticonvulsant Medications
What is the role of vigabatrin in anticonvulsant therapy?
It reversibly inhibits GABA transaminase, the enzyme that breaks down GABA.
p.19
Anticonvulsant Medications
What is the oral bioavailability of Diazepam?
Up to 100% due to its high lipid solubility.
p.7
Anticonvulsant Medications
What are common central nervous system (CNS) effects of carbamazepine?
Antiepileptic effects, headache, diplopia, ataxia, and sedation.
Why should Metaraminol be avoided in pregnancy?
It decreases uterine blood flow and increases uterine contractions.
p.17
Anticonvulsant Medications
How does Aminophylline affect the cardiovascular system?
Increases heart rate (HR), cardiac output (CO), and can be arrhythmogenic at higher doses.
p.14
Pharmacological Management of Asthma
What is the initial treatment for severe and life-threatening asthma?
Correcting hypoxaemia and reducing airways resistance through bronchodilation.
p.21
Antidepressant Classes and Mechanisms
What is the mechanism of action (MOA) of Temazepam?
Agonist at benzodiazepine receptor coupled to GABA receptor, increasing the frequency of opening of GABA’s Cl- ion channel.
p.6
Anticonvulsant Medications
What hematological effects can sodium valproate have?
Thrombocytopenia and impaired clotting.
p.13
Pharmacological Management of Asthma
What is the aim of pharmacological management of asthma?
Disease control defined by absence of symptoms, no activity limitations, and normal lung function.
p.21
Antidepressant Classes and Mechanisms
What are the effects of Temazepam on the cardiovascular system (CVS)?
Minimal respiratory suppression and blunts response to pCO2 at high doses.
p.1
Thiazolidinediones (TZDs)
What are some side effects of Thiazolidinediones?
Increased risks of heart failure, hepatic enzyme derangement, limb fractures, and bladder cancer.
What type of receptors does Metaraminol primarily stimulate?
Mainly α1 receptors with some β activity.
p.19
Anticonvulsant Medications
What is the primary mechanism of action (MOA) of Diazepam?
Agonist at the benzodiazepine receptor coupled to GABA receptor, increasing the frequency of opening of the Cl- ion channel.
p.6
Anticonvulsant Medications
What is the primary use of sodium valproate?
Treatment of epilepsy, especially generalized seizures and infantile spasms.
p.8
Antidepressant Classes and Mechanisms
What are the potential risks associated with antidepressants?
They can cause dependence syndromes, particularly drug withdrawal.
What are the primary uses of Metaraminol?
Hypotension and treatment of priapism (off-license use).
p.6
Anticonvulsant Medications
What is the typical dosage range for sodium valproate?
600–2500 mg/day in 2 divided doses.
p.5
Anticonvulsant Medications
What are some common side effects of Phenytoin?
Hirsutism, gum hyperplasia, and megaloblastic anemia.
p.11
Antidepressant Classes and Mechanisms
What are common side effects of SNRIs?
Dose-dependent hypertension and common GI and CNS side effects similar to SSRIs.
p.13
Pharmacological Management of Asthma
What are common triggers for asthma?
Allergens, tobacco smoke, cold air, exercise, viral infections, and certain drugs.
p.3
Classification of Epilepsy
What is a simple partial seizure?
A seizure where consciousness is preserved and symptoms depend on the origin.
p.3
Anticonvulsant Medications
What are the two main groups of anticonvulsants?
Drugs enhancing GABA-mediated inhibition and drugs modulating sodium flux in nerves.
p.7
Anticonvulsant Medications
What should be monitored with chronic use of carbamazepine?
Liver function tests (LFTs).
p.13
Pharmacological Management of Asthma
What type of respiratory failure can occur during an acute asthma episode?
Type 1 respiratory failure due to ventilation–perfusion mismatching.
p.20
Anaesthesia Considerations for Epileptic Patients
What is the effect of Midazolam on the central nervous system?
Hypnosis, sedation, anxiolysis, anterograde amnesia, and decreased cerebral metabolic oxygen requirements.
p.21
Antidepressant Classes and Mechanisms
How is Temazepam primarily excreted from the body?
In urine (main route) and faeces.
p.13
Pharmacological Management of Asthma
What is the purpose of adding a long-acting β2 agonist in Step 3?
To assess response and improve asthma control.
p.1
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
What are the side effects of Dipeptidyl Peptidase-4 (DPP-4) inhibitors?
Hypersensitivity reactions including anaphylaxis, angioedema, and Stevens-Johnson syndrome.
What is the mechanism of action (MOA) of Flumazenil?
It acts as a competitive antagonist at benzodiazepine receptors.
p.8
Antidepressant Classes and Mechanisms
What is the primary cause of depression according to the text?
An imbalance in neurotransmitters such as serotonin, norepinephrine, and dopamine.
p.23
Pharmacological Management of Asthma
What is the infusion rate for Phenylephrine?
30–60 μg/min, titrated to response.
p.11
Pharmacological Management of Asthma
What is the increased risk associated with certain medications in relation to bleeding?
Increased risk of GI and post-operative bleeding due to inhibition of cytochrome P450, potentiating effects of warfarin and impairing platelet function.
What are the potential central nervous system (CNS) effects of Flumazenil?
It can precipitate seizures and reduce post-operative shivering.
p.23
Pharmacological Management of Asthma
How is Phenylephrine metabolized?
By hepatic metabolism through monoamine oxidase.
p.7
Anticonvulsant Medications
How is carbamazepine metabolized?
Hepatic metabolism to an active compound; induces liver enzymes with chronic use.
How is Flumazenil metabolized and excreted?
It undergoes hepatic metabolism and is excreted in urine, with no significant active metabolites.
p.14
Pharmacological Management of Asthma
What do leukotriene receptor antagonists do?
They block the bronchoconstricting effects of leukotrienes on the airways and act synergistically with inhaled steroids.
p.4
Anticonvulsant Medications
What is the main inhibitory neurotransmitter in the CNS?
GABA (gamma amino-butyric acid).
p.9
Anaesthesia Considerations for Epileptic Patients
Which opioids can be used safely in anaesthesia?
Morphine, fentanyl, alfentanil, and remifentanil.
p.16
Pharmacological Management of Asthma
What effect does Salbutamol have on blood pressure and heart rate at high doses?
Decreases blood pressure (β2) and can increase heart rate and contractility (β1).
p.16
Pharmacological Management of Asthma
What are some other effects of Salbutamol?
Decreases uterine tone, causes hypokalaemia, increases blood glucose and fatty acids, and can cause anxiety and sweating.
p.10
Antidepressant Classes and Mechanisms
What is a potential consequence of abruptly stopping SSRIs?
Withdrawal symptoms or discontinuation syndrome, especially with paroxetine.
p.1
Thiazolidinediones (TZDs)
What is a contraindication for Thiazolidinediones?
Congestive cardiac failure and patients at increased risk of fractures.
p.18
Pharmacological Management of Asthma
What are miscellaneous drugs?
Drugs that do not fit into standard categories and have varied uses.
p.15
Anaesthesia Considerations for Epileptic Patients
What is sevoflurane used for in anaesthesia?
It is a good bronchodilator and may be used in resistant bronchospasm.
p.23
Pharmacological Management of Asthma
What is the recommended bolus dose for Phenylephrine?
50–100 μg, repeated as necessary.
What is the initial cautious bolus dose of Metaraminol?
0.5 mg, titrated to effect.
p.17
Anticonvulsant Medications
What is the oral dose of Aminophylline?
900 mg in 2–3 divided doses.
p.5
Anticonvulsant Medications
How does Phenytoin exert its anticonvulsant effect?
By binding to inactivated fast Na+ channels, reducing sodium influx and stabilizing the membrane.
p.2
Management of Type 2 Diabetes Mellitus
What is the second-line treatment for type 2 diabetes mellitus?
Sulphonylurea to first-line metformin, metformin to first-line sulphonylurea, meglitinides to first-line metformin, and DPP-4 inhibitors or TZDs to first-line metformin or sulphonylurea.
p.4
Anaesthesia Considerations for Epileptic Patients
What should be included in the pre-operative assessment for a patient with epilepsy?
History of epileptic activity, underlying pathology, type and frequency of seizures, occupation, driving status, and drug history.
p.8
Antidepressant Classes and Mechanisms
What is the mode of action of MAOIs?
They prevent the breakdown of monoamine neurotransmitters by inhibiting the monoamine oxidase enzyme.
p.2
Management of Type 2 Diabetes Mellitus
What should be monitored to assess the effectiveness of DPP-4 inhibitors, TZDs, and GLP-1 mimetics?
A beneficial metabolic response, specifically a decrease in HbA1c.
p.17
Anticonvulsant Medications
What are the primary uses of Aminophylline?
Asthma, COPD, hyperkalaemia, and uncomplicated pre-term labour.
p.13
Pharmacological Management of Asthma
How is bronchoconstriction mediated in asthma?
By the parasympathetic nervous system through acetylcholine release.
p.23
Pharmacological Management of Asthma
What effect does Phenylephrine have on renal blood flow?
It decreases renal blood flow.
p.11
Antidepressant Classes and Mechanisms
What are common side effects of Tetracyclic antidepressants?
Sedation and weight gain due to blockade of various postsynaptic 5-HT2 receptors.
p.6
Anticonvulsant Medications
What is the mechanism of action (MOA) of sodium valproate?
Inhibits succinic semialdehyde dehydrogenase, increasing brain levels of GABA, and may stabilize sodium channels.
p.14
Pharmacological Management of Asthma
What steroid doses are recommended for severe asthma treatment?
40 mg prednisolone orally or 200 mg hydrocortisone intravenously followed by 50–100 mg hydrocortisone every 6 hours.
p.1
Thiazolidinediones (TZDs)
What is the mechanism of action (MOA) of Thiazolidinediones?
Increases hepatic sensitivity to insulin, promoting glucose clearance.
p.14
Pharmacological Management of Asthma
What is the use of adrenaline in asthma treatment?
It is an excellent bronchodilator and should be considered in resistant bronchospasm.
p.7
Anticonvulsant Medications
What is the mechanism of action (MOA) of carbamazepine?
Binds to inactivated fast Na+ channels, reducing sodium influx and stabilizing the membrane.
p.15
Anaesthesia Considerations for Epileptic Patients
What caution should be taken with morphine in asthma patients?
It may cause histamine release.
p.16
Pharmacological Management of Asthma
What type of drug is Salbutamol?
A β2 agonist with some small β1 activity.
p.23
Pharmacological Management of Asthma
What is the primary effect of Phenylephrine on systemic vascular resistance (SVR)?
It causes a rapid increase in SVR lasting 5–10 minutes.
p.12
Antidepressant Classes and Mechanisms
What can serotonin syndrome mimic?
Neuroleptic malignant syndrome.
p.16
Pharmacological Management of Asthma
What is the mechanism of action (MOA) of Salbutamol?
Direct stimulation of β2 receptors with less pronounced action at β1 receptors.
What metabolic effects does Metaraminol have?
Inhibits insulin release, causes hyperglycemia, increases lipolysis, and raises basal metabolic rate and temperature.
p.4
Anticonvulsant Medications
What is the effect of GABA receptor activation?
It causes increased flux of chloride or potassium ions into the cell, leading to hyperpolarization of the membrane and stabilizing the synapse.
p.17
Anticonvulsant Medications
What is the renal effect of Aminophylline?
Weakly diuretic, inhibits tubular Na+ reabsorption.
p.8
Anaesthesia Considerations for Epileptic Patients
Which anesthetic agents can be used safely with MAOIs?
Propofol, etomidate, benzodiazepines, and inhalation agents.
p.6
Anticonvulsant Medications
How is sodium valproate metabolized and excreted?
Hepatic metabolism with a small amount excreted unchanged in urine.
p.9
Antidepressant Classes and Mechanisms
What are some examples of tricyclic antidepressants?
Imipramine, amitriptyline, doxepin, and dosulepin.
p.9
Anaesthesia Considerations for Epileptic Patients
What are the implications for anaesthesia when using tricyclic antidepressants?
Increased anaesthetic requirement and potential cardiac depressant effects.
p.12
Antidepressant Classes and Mechanisms
What drug interactions can increase lithium levels?
NSAIDs, loop and thiazide diuretics, and ACE inhibitors.
p.23
Pharmacological Management of Asthma
What is the mechanism of action (MOA) of Phenylephrine?
It is a potent α adrenoreceptor agonist with no effect on β receptors.
p.11
Antidepressant Classes and Mechanisms
What are Serotonin–norepinephrine re-uptake inhibitors (SNRIs)?
Second-generation antidepressants that include venlafaxine and duloxetine.
p.20
Anaesthesia Considerations for Epileptic Patients
What is the mechanism of action (MOA) of Midazolam?
Agonist at the benzodiazepine receptor coupled to GABA receptor, increasing the frequency of opening of GABA’s Cl- ion channel.
p.3
Classification of Epilepsy
What are partial (focal) seizures?
Seizures that occur in one region of the brain.
p.10
Antidepressant Classes and Mechanisms
What are common symptoms of TCA overdose?
Anticholinergic effects, cardio- and neurotoxicity, pulmonary hypoventilation, and metabolic acidosis.
p.14
Pharmacological Management of Asthma
What is a rare association with the use of leukotriene receptor antagonists?
Churg–Strauss syndrome (eosinophilia, vasculitic rash, pulmonary infiltrates).
p.16
Pharmacological Management of Asthma
What are some uses of Salbutamol?
Asthma, COPD, hyperkalaemia, and uncomplicated pre-term labour.
p.13
Pharmacological Management of Asthma
What results from bronchoconstriction in asthma?
Increased airways resistance and reduced expiratory gas flow.
p.20
Anaesthesia Considerations for Epileptic Patients
What effect does Midazolam have on the cardiovascular system?
Decreases systemic vascular resistance (SVR) by one-third and increases heart rate (HR).
p.13
Pharmacological Management of Asthma
What is the first step in the step-wise approach to asthma management?
Inhaled short-acting β2 agonist (e.g., salbutamol) as required.
p.10
Anaesthesia Considerations for Epileptic Patients
What should be considered regarding SSRIs during anesthesia?
Continue peri-operatively and be aware of drug interactions that may precipitate serotonin syndrome.
p.14
Pharmacological Management of Asthma
How does aminophylline work in asthma treatment?
It blocks phosphodiesterase, increasing intracellular cyclic AMP, leading to bronchodilation.
p.1
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
What is the mechanism of action of Dipeptidyl Peptidase-4 (DPP-4) inhibitors?
Increase insulin secretion and lower glucagon secretion by inhibiting DPP-4.
p.12
Anaesthesia Considerations for Epileptic Patients
What is the implication of serotonin syndrome for anaesthesia?
It inhibits the release of brainstem neurotransmitters, reducing the requirement for anaesthetic agents and prolonging neuromuscular blockade.
p.3
Classification of Epilepsy
Name some types of generalized seizures.
Tonic-clonic (Grand mal), Tonic, Myoclonic, Absence (Petit mal), Akinetic.
p.17
Anticonvulsant Medications
What are the common toxicities associated with Aminophylline?
Tachyarrhythmias, tremor, seizures, nausea and vomiting, rhabdomyolysis.
p.20
Anaesthesia Considerations for Epileptic Patients
What happens to the diazepine ring structure of Midazolam at different pH levels?
> 4: ring closed (non-ionised, lipid soluble); < 4: ring open (ionised, less lipid soluble).
p.16
Pharmacological Management of Asthma
What is the recommended dose for Salbutamol using a metered dose inhaler?
100 μg, 2 puffs as needed (prn).
p.23
Pharmacological Management of Asthma
What cardiovascular effects can Phenylephrine cause?
Increased SVR and blood pressure, may cause reflex bradycardia.
p.4
Anticonvulsant Medications
What are the two subtypes of GABA receptors?
GABA-A, a ligand-gated chloride ion channel, and GABA-B, a G-protein-coupled receptor.
p.9
Anaesthesia Considerations for Epileptic Patients
What medications should be avoided due to the risk of serotonin syndrome?
Tramadol, pethidine, and linezolid.
p.16
Pharmacological Management of Asthma
How is Salbutamol metabolized and excreted?
Hepatic metabolism with metabolites and unchanged drug excreted in urine.
p.11
Antidepressant Classes and Mechanisms
What is lithium used for?
A mood stabilizer used in the management of bipolar disorder.
p.11
Antidepressant Classes and Mechanisms
What are signs of lithium toxicity?
CNS: sedation, confusion, tremors; CVS: sinus bradycardia, AV block, hypotension.
p.14
Pharmacological Management of Asthma
What are the potential side effects of intravenous salbutamol?
Severe tachycardia and lactic acidosis.
p.9
Anaesthesia Considerations for Epileptic Patients
What should be avoided in anaesthesia due to exaggerated BP response?
Indirect-acting sympathomimetics and certain direct-acting sympathomimetics should be used in lower doses.
p.17
Anticonvulsant Medications
What is the mechanism of action (MOA) of Aminophylline?
Direct stimulation of β2 receptors with less pronounced action at β1 receptors.
p.8
Antidepressant Classes and Mechanisms
What are monoamine oxidase inhibitors (MAOIs)?
The first class of antidepressants developed, used infrequently now due to lethal interactions.
What cardiovascular effects does Metaraminol have?
Increases systemic vascular resistance (SVR), blood pressure (BP), and coronary artery blood flow.
p.19
Anticonvulsant Medications
What are the cardiovascular effects of Diazepam?
Slight, transient decrease in blood pressure and increased coronary artery vasodilation.
p.21
Antidepressant Classes and Mechanisms
What is the primary use of Temazepam?
Sedation, especially for insomnia.
p.2
Management of Type 2 Diabetes Mellitus
What is the complexity of managing type 2 diabetes mellitus according to NICE guidelines?
It requires blood glucose and HbA1c monitoring, and caters for individual indications, contraindications, lifestyles, and circumstances.
p.17
Anticonvulsant Medications
What effect does Aminophylline have on the respiratory system?
Bronchodilation and increased diaphragmatic contractility.
p.10
Antidepressant Classes and Mechanisms
What are SSRIs and their mode of action?
Second-generation antidepressants that increase serotonin levels by selectively inhibiting its re-uptake.
p.10
Antidepressant Classes and Mechanisms
What are common side effects of SSRIs?
GI effects, CNS effects, sexual dysfunction, and increased risk of bone fractures.
p.13
Pharmacological Management of Asthma
What should be considered if asthma control remains inadequate?
Increase inhaled steroid dose or consider other therapies like leukotriene receptor antagonists or slow-release theophylline.
p.1
Alpha Glucosidase Inhibitors
What is the mechanism of action of Alpha Glucosidase Inhibitors?
Inhibition of intestinal alpha glucosidase, delaying absorption and digestion of sucrose and starch.
p.19
Anticonvulsant Medications
How is Diazepam metabolized?
Hepatic metabolism to active compounds such as Desmethyldiazepam, Oxazepam, and Temazepam.
p.11
Antidepressant Classes and Mechanisms
How do SNRIs work?
They selectively block serotonin (SERT) and norepinephrine transporters (NET) at the presynaptic membrane, increasing levels of serotonin and norepinephrine in the postsynaptic membrane.
p.13
Pharmacological Management of Asthma
What is a common consequence of severe asthma in the UK?
Approximately three deaths per day.
What are some side effects of Metaraminol?
Severe hypertension, nausea and vomiting, tissue necrosis with extravasation.
p.7
Anticonvulsant Medications
What hematological side effects are associated with carbamazepine?
Agranulocytosis, mild neutropenia, and aplastic anemia.
p.10
Antidepressant Classes and Mechanisms
What is the role of activated charcoal in TCA overdose treatment?
To adsorb TCA in the stomach if administered within 2 hours of ingestion.
p.20
Anaesthesia Considerations for Epileptic Patients
What are the primary uses of Midazolam?
Sedation, anxiolysis, and induction of anaesthesia in unstable patients.
p.10
Antidepressant Classes and Mechanisms
How does sodium bicarbonate infusion help in TCA overdose?
It reverses metabolic acidosis, increasing protein binding and reducing bioavailability of TCAs.
p.14
Pharmacological Management of Asthma
What is the role of nebulised salbutamol in asthma treatment?
It is used for oxygen-driven nebulisation to deliver bronchodilation.
p.3
Anticonvulsant Medications
What is the effect of reducing sodium current in anticonvulsant therapy?
It prevents the repetitive opening and closing of fast Na+ channels, reducing action potentials.
p.13
Pharmacological Management of Asthma
What is added in Step 2 of asthma management?
Inhaled steroid 200–800 μg/day.
p.14
Pharmacological Management of Asthma
What is heliox and its theoretical benefit in asthma?
A mixture of helium and oxygen that may improve gas flow by reducing work of breathing, though not recommended by the British Thoracic Society.
p.2
Management of Type 2 Diabetes Mellitus
What are the third-line treatments for type 2 diabetes mellitus?
Insulin to metformin and sulphonylurea, exenatide to metformin and sulphonylurea, and DPP-4 inhibitors or TZDs to metformin and sulphonylurea.
p.4
Anaesthesia Considerations for Epileptic Patients
What anesthetic agents should be avoided in patients with epilepsy?
Ketamine and etomidate, as they can lower the seizure threshold.
p.5
Anticonvulsant Medications
What teratogenic effects can Phenytoin cause?
Craniofacial abnormalities, limb abnormalities, and growth retardation.
p.11
Anaesthesia Considerations for Epileptic Patients
What are the implications for anaesthesia when using SNRIs?
Continue peri-operatively; may potentiate effects of warfarin; avoid drug interactions that could cause serotonin syndrome.
p.12
Antidepressant Classes and Mechanisms
What is the treatment approach for serotonin syndrome?
Mainly supportive care, usually requiring intensive care.
p.11
Antidepressant Classes and Mechanisms
What are Tetracyclic antidepressants (TeCAs)?
Antidepressants such as mianserin and mirtazapine that promote noradrenergic and serotonergic neurotransmission via α2 antagonism.
p.6
Anticonvulsant Medications
What are some common side effects of sodium valproate?
Drowsiness, hepatic dysfunction, pancreatitis, nausea, vomiting, hair loss, weight gain, and edema.
p.8
Anaesthesia Considerations for Epileptic Patients
What is a significant implication for anaesthesia when using MAOIs?
They reduce the metabolism of barbiturates, requiring lower doses.
p.9
Anaesthesia Considerations for Epileptic Patients
What should be considered when using local anaesthetics containing adrenaline?
They should be used with caution.
p.9
Anaesthesia Considerations for Epileptic Patients
Why are indirect-acting sympathomimetics contraindicated?
They may precipitate potentially fatal hypertensive crises.
p.14
Pharmacological Management of Asthma
What is the role of magnesium sulfate in asthma management?
It is an excellent smooth muscle dilator and is administered intravenously.
p.1
Thiazolidinediones (TZDs)
In which situations are Thiazolidinediones indicated?
Used in combination with metformin or sulphonylureas, or as monotherapy.
p.1
Alpha Glucosidase Inhibitors
What are the common side effects of Alpha Glucosidase Inhibitors?
High chance of gastrointestinal adverse effects, particularly flatulence and diarrhea.
p.1
Non-Insulin Injectables
What is a significant benefit of glucagon-like peptide-1 mimetics?
Significant weight loss, appropriate for patients with BMI > 35 kg/m².
p.19
Anticonvulsant Medications
What are some central nervous system (CNS) effects of Diazepam?
Anticonvulsant effects, hypnosis, sedation, anxiolysis, anterograde amnesia, drowsiness, and ataxia.
p.5
Anticonvulsant Medications
What is a significant risk when administering Phenytoin rapidly?
Heart block, ventricular fibrillation, and asystole.
p.3
Anticonvulsant Medications
Name some drugs that enhance GABA-mediated inhibition.
Benzodiazepines, barbiturates, sodium valproate, and vigabatrin.
p.9
Antidepressant Classes and Mechanisms
What is the mode of action of tricyclic antidepressants?
They act primarily as serotonin-norepinephrine re-uptake inhibitors.
p.9
Antidepressant Classes and Mechanisms
What are common side effects of tricyclic antidepressants?
Anticholinergic effects, changes in appetite, CNS effects, and cardiovascular issues.
p.3
Anticonvulsant Medications
How do drugs that modulate sodium flux work?
They bind to inactivated fast Na+ channels, reducing sodium influx and stabilizing membranes.
p.11
Antidepressant Classes and Mechanisms
What are the side effects of lithium?
GI issues (nausea, vomiting, diarrhea), CNS effects (headache, sedation, tremors), hypothyroidism, and risk of lithium toxicity.
p.21
Antidepressant Classes and Mechanisms
What are the central nervous system (CNS) effects of Temazepam?
Hypnosis, sedation, and anxiolysis.
p.14
Pharmacological Management of Asthma
What is the role of ketamine in life-threatening asthma?
It is an NMDA receptor antagonist with bronchodilating properties, used for sedation and treatment of bronchoconstriction.
p.1
Non-Insulin Injectables
What is the mechanism of action of glucagon-like peptide-1 mimetics?
Acts as an incretin-mimetic and is given by subcutaneous injection before meals.
