Big Pharma Flashcards
Give a common SE of amlodipine
Ankle oedema
How may macrolides affect an ECG?
Lengthening of the QT interval
What complication may be prevented by the co-prescription of pyridoxine in TB?
The risk of peripheral neuropathy with isoniazid can be reduced by prescribing pyridoxine
What do we use sildenafil for in neonates?
Pulmonary hypertension
Which electrolyte abnormality may predispose you to digoxin toxicity?
Hypokalaemia
How do we treat beta blocker overdose?
IV atropine
What is pioglitazone, and where is it contraindicated?
Pioglitazone is a thiazolidinedione, which works by increasing insulin sensitivity in peripheral tissues and decreasing hepatic gluconeogenesis. However, it can cause fluid retention and exacerbate heart failure, making it unsuitable for patients with pre-existing heart failure.
What is gentamicin?
aminoglycoside
What are the main SEs of rifampicin?
It can cause various side effects including hepatotoxicity (liver damage), orange discolouration of body fluids, flu-like syndrome and thrombocytopenia among others.
What are the main SEs of pyrazinamide?
Its main adverse effect is hepatotoxicity which may present as jaundice or elevated liver enzymes in blood tests.
What are the main SEs of ethambutol?
primarily affects the eyes causing optic neuritis which may lead to decreased visual acuity or red-green colour blindness but it does not cause peripheral neuropathy.
Give a common SE of ciprofloxacin
Tendinopathy
A 40-year-old man presents after taking an overdose of amitriptyline. His ECG on arrival shows widening of the QRS complex. Treatment?
IV Bicarbonate
What is pyridoxine?
a form of vitamin B6 which is prescribed alongside isoniazid to reduce the risk of peripheral neuropathy
Which drugs should we avoid in AKI?
D - Diuretics
A - ACE inhibitor, ARBs
M - Metformin
N - NSAIDs
How does lithium toxicity present?
Diarrhoea, vomiting, abdominal pain, coarse tremor, weakness, seizures, muscle twitches and blurred vision are among the signs and symptoms of lithium toxicity
Why do we hold metformin in AKI?
Risk of lactic acidosis
What is the main SE of amiodarone that we need to inform pts of?
Pulmonary fibrosis
What is the earliest symptom of aspirin overdose
Tinnitus
Give a urinary SE of amitryptiline?
Retention
When is cranberry juice contraindicated?
Cranberry juice does not interact with lithium. However, it increases the risk of rhabdomyolysis when taken with statins due to its inhibitory effect on cytochrome P450.
Which painkiller can precipitate lithium toxicity?
NSAIDs
Tx for a farmer is admitted with suspected organophosphate insecticide poisoning
Causes bradycardia - atropine
Tx for a pt with iron overdose
Desferrioxamine
Tx for a pt with antifreeze overdose
Fomepizole
Give the main SE of Mg replacement
Diarrhoea is the major dose-limiting side effect of magnesium salts
A 62-year-old man is admitted following a beta-blocker overdose. He remains bradycardic despite being given atropine. Tx?
Glucagon
What are tetracyclines used for, and what is a common SE?
Tetracyclines are a group of broad-spectrum antibiotics that are known to cause photosensitivity reactions, which can result in a skin rash. This happens because tetracyclines can increase the skin’s sensitivity to sunlight and ultraviolet light. Photosensitivity reactions are considered as one of the common side effects of tetracyclines.
Which side-effect is most characteristically associated with metronidazole
Alcohol interaction
Which side-effect is most characteristically associated with doxy?
Photosensitivity
Give three SEs of calcium channel blockers
Calcium channel blockers - side-effects: headache, flushing, ankle oedema
What is nicorandil, and when is it contraindicated?
Nicorandil, on the other hand, is a potassium channel activator with a nitrate component. The concurrent use of sildenafil and nicorandil can lead to an excessive drop in blood pressure due to their combined vasodilatory effects.
Which diuretics can cause digoxin toxicity?
Thiazides
What feature is characteristic of ecstasy overdose?
Ecstasy, also known as MDMA (3,4-methylenedioxymethamphetamine), is a synthetic psychoactive drug that can cause a range of physical and psychological effects. One of the most characteristic features of ecstasy use is hyperthermia, with body temperatures often exceeding 39ºC. This occurs due to increased serotonin release in the hypothalamus, which regulates body temperature.
A transaminitis (elevated ALT and AST) in the 10,000s is most commonly caused by
Paracetamol OD
What is the most common side effect of sildenafil?
Headache
A 50-year-old woman who has dislocated her shoulder is accidentally given 10mg, rather than 1mg, of lorazepam. She stops breathing but still has a cardiac output. Tx?
Flumazenil
A 30-year-old woman presents to the Emergency Department. She bought a cheap bottle of vodka from the market and drank it two hours ago. She has since heard however that it contains methanol and is now worried as she has a headache and feels dizzy. Tx?
Ethanol
A 59-year-old man takes a deliberate overdose of 60 digoxin 125mcg tablets. He presents to the Emergency Department three hours later. Tx?
Specific antibodies
How do we monitor gliclazide
No monitoring required
How do we monitor azathiopurine?
FBC, LFT
How do we monitor simvastatin?
LFT over first 12 months (baseline, 1m, 12m)
When do we give cyclical HRT?
if their LMP was less than 1 year ago
When do we give continuous HRT?
continuous combined HRT if they have:
taken cyclical combined for at least 1 year or
it has been at least 1 year since their LMP or
it has been at least 2 years since their LMP, if they had premature menopause (menopause below the age of 40)
What drug causes blue vision?
Viagra
Blue vision is better than blue balls
Which drugs causes yellow-green vision?
Yellow-green vision: digoxin
Give a common SE of mefloquine
Mefloquine, an antimalarial medication, has been linked to neuropsychiatric side effects such as anxiety and depression. According to UK guidelines, mefloquine should not be prescribed for individuals with a history of psychiatric disorders including anxiety and depression
Which TB treatments impact INR?
RifAMPicin = AMPs up CYP450 - decreases INR
Isoniazid = Inhibits - increases INR
What is the action of aspirin?
Aspirin is a non reversible COX 1 and 2 inhibitor
How do we monitor sodium valproate?
LFT
How do we monitor Pioglitazone?
LFT
What are the causes of digoxin toxicity?
Low
- HypoK, HypoMg, Hypoalbumin, Hypothermia/thyroidism
Potassium
- Drugs which lower potassium eg. thiazides / loop diuretics
CAN
- hyperCa, high Acid (acidosis), hyperNa
Hurt/heart
- Common heart drugs eg. Amiodarone, diltiazem, verapmail, spirinolactone
How does allopurinol impact azathioprine levels?
Allopurinol increases risk of azathioprine toxicity
When is diclofenac contra-indicated?
Any form of heart disease
Give a common SE of opioid medication
Urinary retention
Which abnormality would you see on ABG in cocaine overdose
it often results in metabolic acidosis due to increased lactate production from tissue ischemia and rhabdomyolysis. This occurs as a result of cocaine’s sympathomimetic effects which increase the body’s demand for oxygen, leading to tissue hypoxia.
How do we monitor amiodarone initiation?
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
How do we monitor unfractionated heparin?
Unlike low molecular weight heparins that do not require monitoring unfractionated heparin does require monitoring, this is done by measuring the APTT.
What are the ocular SEs of amiodarone?
Amiodarone therapy can result in both corneal opacities and optic neuritis
Which drugs are associated with retinopathy?
Quinines
Which antibiotic do we need to avoid in CKD 3 when treating UTI?
In order to be effective at treating urinary tract infections, nitrofurantoin needs to be concentrated in the urine and an adequate glomerular filtration is required for this to occur. An eGFR of less than 40-60ml/min means that the drug is wholly ineffective as a bactericidal agent and is not recommended in patients with CKD stage 3 or worse due to the likelihood of treatment failure. Coupled with this is the risk of drug toxicity in the patient. Without adequate renal filtration, the drug is likely to accumulate.
A 24-year-old bi-polar woman comes to the GP clinic as she wants a review of her medications as she’s wanting to become pregnant. She is currently taking lithium as a mood stabiliser.
Which foetal abnormality would you be concerned about with this medication?
Ebstein’s anomaly
Which drugs can cause thrombocytopenia?
Just think QANADAH (Canada)
Q - quinine
A - abciximab
N - NSAIDs
A - antibiotics (penicillin, sulphonamides, rifampicin)
D - diuretics (furosemide)
A - anticonvulsants (carbamezapine, valproate)
H - heparin
Give a common SE of herceptin
Trastuzumab (Herceptin) - cardiac toxicity is common
How do we monitor digoxin once started?
No monitoring required unless toxicity suspected
What is the mechanism of metformin?
Its primary mechanism of action involves decreasing hepatic gluconeogenesis and increasing peripheral insulin sensitivity, but it doesn’t stimulate the pancreas to secrete more insulin.
What can predispose pts to digoxin toxicity?
Hypokalaemia
Patients with MI secondary to cocaine use should be given…
Patients with MI secondary to cocaine use should be given IV benzodiazepines as part of acute (ACS) treatment
ischaemia is caused by coronary artery vasospasm
What is the most likely SE of taking tamoxifen
Flushes
What are the liver transplantation criteria in pcm od
Liver transplantation criteria in paracetamol overdose: pH < 7.3 more than 24 hours after ingestion
What are the P450 enzyme inducers?
CRAP GPS induces my rage
Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
