Chapter 2 - Pharmacology & Toxicolgy

Question 1

Presentation of drug induced lupus

Answer 1

Triad:
Arthralgia
Butterfly Rash
Pleurisy

Question 2

Common causes of drug-induced lupus

Answer 2

B-blockers
Phenytoin
Isoniazid
Lithium
Flecainide
Haloperidol
Penicillin
Tetracyclines

Question 3

Drugs impeded by CYP induction

Answer 3

Hydrocortisone
OCP
Phenytoin
Warfarin

Question 4

Drugs that jnduce liver enzymes

Answer 4

Barbiturates
Sulphonylureas

Carbamazepine
Rifampicin
Alcohol (chronic), amiodarone
Phenytoin

Griseofulvin
Smoking

Question 5

Drugs potentiated by liver enzyme inhibitors

Answer 5

Carbamazepine
Ciclosporin
Phenytoin
Theophyllines
Warfarin

Question 6

Drugs that inhibit CYP enzymes

Answer 6

Sulphonamides
Isoniazid
Ciprofloxacin
Ketoconazole

Fluoxetine
Allopurinol, acute alcohol
Cimetidine
Erythromycin
Sodium valproate

Chloramphenicol
Omeprazole
Metronidazole

Question 7

Factors that affect OCP

Answer 7

Absorption (diarrhoea)
Enzyme inducers
Gut flora (enterohepatic oestrogen cycling) - antibiotics

Question 8

Drugs for breastfeeding mothers to avoid

Answer 8

Amiodarone - thyroid
Cytotoxics/chloramphenicol - dyscrasias

Gold - haem/renal
Indomethacin - seizure 
Iodides - thyroid 
Lithium - involuntary movements 
Oestrogen- feminisation of male infant

Question 9

Teratogenic medications

Answer 9

ACEi/ARB - oligohydramnios
Lithium - cardiac
Phenytoin- facial fusion 
Sodium valproate - ntds
Warfarin - long bone anomalies

> 16 weeks
Carbimazole - goitre
Gentamicin - CN VIII sensorineural deafness

Question 10

Drugs that accumulate in renal failure

Answer 10

Atenolol
Digoxin
Enoxaparin
Erythromycin 
Lithium
Penicillin 
Cephalosporins

Question 11

Chimeric monoclonal antibody that irreversibly binds GpIIb/IIIa

Answer 11

Abciximab - can only be used once in any individual

Question 12

A purine nucleoside characterised by short half life

Answer 12

Adenosine - for SVT termination

Question 13

Side effects of adenosine?

Answer 13

Anxiety
Chest tightening
Bronchospasm (c/I in asthmatics)
Facial flushing

Question 14

Mechanism of Aliskiren

Answer 14

Direct renin inhibitor prevents angiotensinogen to angiotensin I conversion

Question 15

Highly protein binding and long half life associated with which drug?

Answer 15

Amiodarone

Question 16

Side effects of amiodarone

Answer 16

Arrhythmia (torsades due to QT prolongation)
Ataxia
Alveolitis
Hepatitis
Thyroid (hyper or hypo)
Peripheral neuropathy
Photo sensitivity
Pulm fibrosis
Grey skin

Question 17

How does ACEi cause cough?

Answer 17

Increased Kirin concentration in alveoli/bronchi

Question 18

Cautions with ACEi

Answer 18

Renal artery stenosis

Severe renal impairment

Question 19

Mechanism of digoxin in AF

Answer 19

NA+/K+/ATPase inhibitor - increased intracellular Na prolongs phase 4 and 0, AV nodal delay.
Increased intracellular Ca2+ - increased contracility
Vagus stimulation - further AV nodal prolongation

Question 20

Digoxin toxicity

Answer 20

Anorexia
N&V
Arrhythmia
Yellow vision (xanthopsia)
Diarrhoea

Precipitated by electrolyte imbalance (Hypokalaemia, Hypomagnasaemia, Hypercalcaemia)

Question 21

Flecainide class and indication

Answer 21

1c antiarrhythmic - sodium blocker prolongs phase 1

For acute cardioversion of AF

Question 22

Statin indications

Answer 22

MI
DM
HTN
CVD risk factors/PVD

Question 23

Ivabradine mechanism

Answer 23

K+ opener causing peripheral arterial vasodilatation. Nitrate component causes venous relaxation.

Question 24

Non-diuretic indication for thiazides

Answer 24

Blood pressure management. Majority of effect at minimal dose

Question 25

Thiazide side-effects

Answer 25

Dose-dependent:
HypoNa/K/Mg; hyperchloraemic acidosis
Raised urate (reduce tubular clearance); gout
Poor glycaemic control in diabetics
Postural hypotension; photosensitivity

Dose indepedent
Agranulocytosis
Pancreatitis
Thrombocytopenia