1

Question 1

Inducers of p450 enzyme (inc breakdown of other drugs)

Answer 1

antiepileptics (phenytoin, carbamezapine)
barbiturates (phenobarbitone)
rifampicin
st johns wort
chronic alcohol intake
griseofulvin
smoking

Question 2

Inhibitors of p450 enzyme (inc product)

Answer 2

abx (ciprofloxacin, erythromycin)
isoniazid
omeprazole, cimetidine
allopurinol
amiodarone
imidazoles (ketoconazole, fluconazole)
ssris (fluoxetine, sertralin)
ritonavir
sodium valp
acute alc intake
quinupristin

Question 3

Carbon monoxide poisoning
- pathophy
- symp
- ix
- mx

Answer 3

Carbon monoxide poisoning
- pathophy: CO binds to hb as higher affinity means less oxy carrying capacity (R->L shift) dec oxygen sats
- symp: headache, n+v, vertigo, confusion, weak, if sev pink skin/mucosa/hyperpyrexia/arrythmia
- ix : (pulse oximetry may be falsely high), vbg/abg
- mx: 100% high flow oxy, hyperbaric oxy

Question 4

Carbimazole:
- indic
- se
- contraind

Answer 4

Carbimazole:
- indic: hyperthy
- se: agranulocytosis, pancreatitis, alopecia, angioedema, dyspepsia, fever, gi issues, lymphad, headache, haemorrhage, hepatic disorders
- Containd: bleeding disorders, preg

Question 5

Nicotine replacement:
- types

Answer 5

• NRT, varenicline, bupropion - provide enough for post 2 weeks target date (normally 2 weeks of NRT or 2-4 weeks of others needed) - if unsuccessful wait 6 months
• NRT se: n+v, headache, flu symp. Offer patches with another form (gum, inhalator, nasal spay) if high dependance
• varenicline: nicotine rec partial antag, n+v, headache, insomnia, abnormal dreams, caution if mental health
• bupropion: na dopamine reuptake inhibitor + nicotine antag - seizures (contraind if epilepsy)
• Preg/ feeding: test via carbon monoxide detector - cbt, nrt

Question 6

Allopurinol:

• se
• monitoring

Answer 6

• se: rash, hepatic impairment, n+v
• monitoring: lfts every 3 months for first year