Before exam Flashcards
1
Q
What are the types of adverse drug reaction
A
A
- Common
- unlikely to be fatal
B
- Rare
- likely to be fatal
C
- related to cumulative dose
- time related
D
- delayed
- usually dose related
- occurs or becomes apparent some time after use of drugs
E
- happens when you suddenly stop taking the drug
F
- failure
- drug interactions leads to failure
2
Q
ADRs are common in
A
- more than 10% of patients
3
Q
ADRs that are uncommon occur in
A
- more than 0.1% but less than 1% of patients
4
Q
ADRs that are rare occur in
A
- more than 0.01% but less than 0.1% of patients
5
Q
ADRs that are very rare occur in
A
- less than 0.01% of patients
6
Q
What is the volume of distribution ratio
A
Vd = total amount of drug in the body/ plasma drug concentration
7
Q
What drugs have a higher and low Volume Distribution
A
- Drugs which are highly water soluble (gentamicin, atenolol and insulin_ or extensively protein bound( e.g. warfarin) have a relatively low Vd since they stay in the plasma
- Drugs which are highly lipid soluble (e.g. digoxin, morphine, and diazepam) have a larger volume distribution since these drugs go out of plasma into tissues and organs
8
Q
What is first order elimination
A
- this is when half life is independent of drug concentration
9
Q
What is zero order elimination
A
- when the enzyme is saturated only a fixed amount per hour is removed from the body
10
Q
name the sum of total body clearance
A
CL=CLh +CLr
- total body clearance is the sum of the individual clearances for each elimination tissue or organ (renal and hepatic)
11
Q
what is the elimination rate constant (K)
A
- K= Cl/Vd
- the greater the fraction of drug removed in unit time the shorter the half life, thereofre half life varies inversely with elimination rate cnstant
12
Q
What are unlicensed preparations
A
this is when there is a need to use a medicine that doesn’t have a product authorisation in the UK
13
Q
What are the three categories of unlicensed preparations
A
- the medicine is produced and licensed in another country and imported
- the medicine is unlicensed and produced in a licensed manufacturing unit in this country
- the medicine is unlicensed and produced in an unlicensed manufacturing facility such as a pharmacy department
14
Q
How do you know if a person can make a specific decision
A
- understand information about the decision to be made
- be able to retain that information
- be able to use that information to make their decision
- be able to communicate that decision back to you
15
Q
what drugs can induce nephrotoxicity
A
- aminoglycosides
- amphotericin
- cytotoxic chemotherapy
- diuretics
- immunosuppressants
- lithium salts
- NSAIDs/COX-2 inhibitors
- radiocontrast media
16
Q
Who should ACE/ARB inhibitors be offered to patients with CKD and..
A
- diabetes mellitus and an ACR of 3 mg/mmol or more (ACR A2 or A3)
- Hypertension and an ACE or 30 mg/mmol or more (ACE A3).
- an ACR of 70 mg/mmol or more, irrespective of whether the patient is hypertensive or has cardiovascular disease
17
Q
what level of potassium concentration should be treated straight away
A
- Treat hyperkalaemia urgently if the serum potassium concentration reaches 6.5 mmol/k
18
Q
How many
- Grams in a Kg
- how many mg in a g
- how many micrograms in an mg
- how many nanograms in a microgram
A
- 1Kg = 1000g
- 1g = 1000mg (milligrams)
- 1mg = 1000 micrograms
- 1 microgram = 1000 nanograms
19
Q
What is % w/v
A
- this represents percentage weight per volume
- this is used when a defined weight of a medicine (or chemical) is added to a volume of diluent
- in a 1% w/v solution there is 1g of drug in 100ml of the final product
20
Q
TH1 cytokines
A
IL-12 causes proliferation into TH1
TH1 produces - IL-2, Interferon gamma, TNF alpha
21
Q
TH2 cytokines
A
IL-4 causes proliferation into TH2
TH2 produces - IL-4, IL-5, IL-13
22
Q
What antibody test is used in pernicious anaemia
A
Anti intrinsic factor antibodies
23
Q
What do the blood results of GP6D show
A
Heniz bodies
Bite and blister cells
24
Q
What is the difference between sequestration and aplastic anaemia in sickle cell disease
A
Sudden fall in haemoglobin and reduced reticulocyte is indicative of aplastic crisis whereas sequstration has raised reticulocytes
25
What is first line for polycythaemia vera
Venesection
26
What can polycythaemia vera transform into
AML or myelofibrosis
27
How do you treat TACO
IV diuretics
28
What cancer gets more painful when drinking alcohol
Hodgkin lymphoma
29
What blood film indicates sickle cell anaemia
High reticulocytes and haemoglobin low indicates sickle cell anaemia
30
What is the most common thrombophilia
Activated protein C resistance (Factor V Leiden) is the most common inherited thrombophilia = In patients with factor V Leiden, activated factor V is inactivated 10 times more slowly by activated protein C than normal
31
What is another name for factor V Leiden
- Activated protein C resistance
32
Typical blood findings on a blood film in hyposplenism
Howell-Jolly bodies and siderocytes
33
How can myelofirbosis present on a blood film
thrombocytosis, anaemia, and raised LDH and uric acid.
34
What cancer does myleodysplasia progress to
acute myeloid leukaemia
35
What is the mutation in Burkitts lymphoma
c-myc gene translocation
36
What is the most common form of lymphoma
Diffuse large B cell lymphoma is by far the most common form of lymphoma in the UK
37
What is atelectasis
is a common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty. It is caused when airways become obstructed by bronchial secretions
- should be suspected int he presentation of dyspnoea and hypoxaemia around 72 hours post operatively
38
How do you treat atelectasis
positioning the patient upright
| chest physiotherapy: breathing exercises
39
How do you treat antiphophoslipid disease in pregnancy
aspirin + LMWH
40
What is a common blood finding in alcohol liver disease
Thrombocytopenia is a common finding in alcoholic liver disease
41
What Hodgkin lymphoma has the best prognosis
lymphocyte predominant
42
What is the most common Hodgkin lymphoma
Nodular sclerosing
43
Difference between APTT and PT
APTT - Inartistic and common
PT - extrinsic and common
44
what is the ratio of the therapeutic index
toxic/therapeutic
T1 = TD50/ED50
45
name the sites of action of antimicrobials
Cell wall synthesis
- B- lactase
- Glycopepetides
DNA gyrase
- DNA gyrase- Quinolones
- DNA replication = Metronidazole
DNA- directed RNA polymerase
- rifampicin
Protein synthesis 50S inhibitors
- chloramphenicol
- macrolides
- clindamycin
Protein synthesis 30S inhibitors
- aminoglycosides
- tetracyclines
Cell wall
Cytoplasmic membrane structure
- polymixins
Folic acid metabolism
- DHF - dihydrofolate
- THF - tetrahydrofolate
46
Name examples of beta lactams
Beta lactam agents
- pencillins
- cepsphosporins
- carbapenems
- aztreonam
47
Name some examples of glycopeptides
- vancomycin
| - teicoplanin
48
name an example of carbapenems
Meropenem
49
what is red man syndrome
Red man syndrome (RMS) is a reaction caused by the rapid infusion of the glycopeptide antibiotic Vancomycin.
effects
- pruritic erythematous rash to the face, neck and upper torso
- can involve extremities to a lesser degree
50
Name some examples of aminoglycosides
Gentamicin and Amikacin
51
Name some examples of macrolides
erythromycin,
clarithromycin
azithromycin
52
list examples of quinolone
Ciprofloxacin
moxifloxacin
leveofloxacin
53
Name two examples of antifolates
- Sulphonamides
| - Trimethoprim
54
What is the first line treatment for bronchiectasis
physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
postural drainage
antibiotics for exacerbations + long-term rotating antibiotics in severe cases
bronchodilators in selected cases
immunisations
surgery in selected cases (e.g. Localised disease)
55
What do stomach cells produce
Goblet cells - mucus
Parietal cells - gastric acid
Chief cells - pepsinogen
D cells - somatostatin (inhibits acid secretion)
G cells - gastrin (stimulates acid secretion)
56
What are the vagal manoeuvres
Vagal manourve types
• Czermak–Hering test = consisting of the application of external digital pressure to the carotid sinus.
• Oculocardiac reflex (also known as Aschner–Dagnini reflex) = traction applied to extraocular musclesand/or compression of the eyeball
• Valsalva maneuver = The Valsalva maneuver is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while expelling air out as if blowing up a balloon.
• Mammalian diving reflex = The diving reflex is triggered specifically by chilling and wetting the nostrils and face while breath-holding,
57
Non dihydrpyridine v dihydropyridine
```
Non dihydropyridine
- Verapamil
- Diltiazem
Dihydropyridine
- Amolipine
- Nifidipine
```
58
eGFR stages
```
Stage 1 =>90
Stage 2 = 60-90
Stage 3 = 30-59
Stage 4 = 29-15
Stage 5 = <15
```
59
Valve sounds
- Ejection systolic
- Pansystolic
- early diastolic
- Late diastolic
Ejection systolic
- aortic stenosis (louder on expiration)
- pulmonary stenosis (louder on inspiration) = prominent a wave in JVP
Pansystolic
- mitral regurgitation (louder on expiration)
- tricuspid regurgitation (louder on inspiration) = giant V waves and prominent Y descent in JVP
- VSD
early diastolic
- Aortic regurgitation
mid-Late diastolic
- Mitral stenosis
- tricuspid stenosis
60
What is the most common type of breast cancer
Ductal
61
What is haemolytic ureic syndrome
Haemolytic uraemic syndrome is generally seen in young children and produces a triad of:
- acute kidney injury
- microangiopathic haemolytic anaemia
- thrombocytopenia
treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
62
What is Budd chair syndrome
Budd-Chiari syndrome, or hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition.
Causes
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
combined oral contraceptive pill: accounts for around 20% of cases
The features are classically a triad of:
abdominal pain: sudden onset, severe
ascites → abdominal distension
tender hepatomegaly
Investigations
ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation
