9.

Question 1

SEs of Amiodarone

Answer 1

• intestitial lung disease (pulmonary fibrosis)
• thyroid disease (both hypo and hyper)
• grey skin
• corneal deposits

Question 2

SEs of Lithium

Answer 2

• Early: tremor
• Intermediate: tiredness
• Late: arrhythmias, seizures, coma, renal failure, diabetes insipidus

Question 3

SEs of Haloperidol

Answer 3

• dyskinesias e.g. acute dystonic reactions
• drowsiness

Question 4

SEs of Clozapine

Answer 4

• agranulocytosis

(therefore FBC monitoring is required)

Question 5

SEs of dexamethasone and prednisolone

Answer 5

• stomach ulcers
• thinning of the skin
• oedema
• HF
• osteoporosis
• being prone to infections
• hyperglycemia (but less commonly progress to diabetes)
• Cushing’s syndrome

Question 6

SEs of Fludrocortisone

Answer 6

• hypertension
• sodium and water retention

Question 7

mnemonic for Cytochrome P450 INDUCERS

Answer 7

PC BRAS

Phenytoin

Carbamazepine

Barbiturates

Rifampicin

Alcohol (chronic)

Sulphanylureas

Question 8

Menon is for enzyme INHIBITORS

Answer 8

A ODE VICES

Allopurinol

Omeprazole

Disulfiram

Erythromycin

Valproate

Isoniazid

Ciprofloxacin

Ethanol (acute)

Sulphonamides

Question 9

Most common enzyme inhibitors

Answer 9

• ketoconazole
• ciprofloxacin
• erythromycin
• grapefruit juice

Question 12

When an overdose is considered staggered?

Answer 12

an overdose is considered staggered if all the tablets were not taken within 1 hour

Question 13

Medications that are usually prescribed weekly (2)

Answer 13

• bisphosphonates
• methotrexate

Question 14

Medications that can exacerbate heart failure (i.e. should not be prescribed in HF)

Answer 14

• thiazolidinediones
  
  • pioglitazone is contraindicated as it causes fluid retention
• verapamil
  
  • negative inotropic effect
• NSAIDs/glucocorticoids
  
  • should be used with caution as they cause fluid retention
  • low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks
• class I antiarrhythmics
  
  • flecainide (negative inotropic and proarrhythmic effect)

Question 15

When a gradual withdrawal of steroids is indicated?

Answer 15

Gradual withdrawal of systemic corticosteroids if patients have:

• received more than 40mg prednisolone daily for more than one week
• received more than 3 weeks treatment
• recently received repeated courses

Question 16

What to do to a dose of long-term steroid in an ill patient?

Answer 16

patients on long-term steroids should have their doses doubled during intercurrent illness

Question 17

Difference between Chlorphenamine vs Chlorpromazine

Answer 17

• chlorphenamine: antihistamine
• chlorpromazine: antipsychotic

Question 18

Difference between Carbimazole vs Carbamazepine

Answer 18

• carbimazole: antithyroid
• carbmazepine: antiepileptic

Question 19

Drugs to be avoided while breastfeeding

Answer 19

• antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
• psychiatric drugs: lithium, benzodiazepines
• aspirin
• carbimazole
• methotrexate
• sulfonylureas
• cytotoxic drugs
• amiodarone

Question 20

Drugs that can exacerbate psoriasis

Answer 20

The following factors may exacerbate psoriasis:

• trauma
• alcohol
• drugs: beta-blockers, lithium, antimalarials (chloroquine /hydroxychloroquine), NSAIDs , ACE inhibitors, infliximab
• withdrawal of systemic steroids

Streptococcal infection may trigger guttate psoriasis.