Clin Pharm Flashcards by Maia Cunningham

Person who has OD on 5 different drugs including opiates and benzos, given naloxone in ambulance without response, GCS 10, what treatment do you give?

Naloxone again
Flumenazil
Intubate
Naltrexone
Some other stuff

Naloxone again

From NZF - you can give many doses of naloxone (400first then 800 in 1 min, then 800 again, then 2g!)

Though flumenazil is an antidote for benzos, cant use in intentional/mixed overdose bc causes seizures.

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A 75yo woman with progressive heart failure is to be treated with a diuretic. Furosemide and bumetanide have the same mechanism of diuretic action. Furosemide at a dose of 40mg produces the same magnitude of diuresis as bumetanide 1mg. Which statement is true?
A) Frusemide is less efficacious than bumetanide
B) Bumetanide is about 40x more potent than furosemide
C) The toxicity of bumetanide is greater than furosemide
D) Bumetanide is safer than furosemide
E) The EC50 for bumetanide is less than furosemide

B+ E both true

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When tested under identical conditions drug X has the following parameters: LD50=0.5 mg/Kg
EC50=0.5 µg/Kg. The therapeutic index is
0.001
0.1
1.0
10
1000

1000

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A 50 yo male farm worker is brought to the ED. He was found confused in the orchard and since then has lost consciousness. His heart rate is 45, and his blood pressure is 80/44. He is sweating and salivating profusely. Which of the following treatments is indicated?
A. Physostigmine
B. Noradrenaline
C. Atropine
D. Salbutamol
E. Metoprolol

Atropine (anti-cholinergic)

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In general, anticholinergic drugs should be avoided in patients suffering which of the following?
1) Alzheimer’s dementia
2) Asthma
3) Bradycardia
4) Parkinson’s disease

1) Alzheimer’s dementia

Helps all the rest
Bronchodilates, decreases dopamine, helps in bradycardia.

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A 69 yo asthmatic man comes in for a checkup and complains that he is having some difficulty in “starting to urinate”. Physical exam indicates that the man has a BP of 160/100 and a slightly enlarged prostate. Which of the following medications would be useful in treating both of these conditions?
A. Doxazosin
B. Labetalol
C. Phentolamine
D. Atenolol
E. Oxybutinin

Doxazosin

smooth muscle relaxation of prostate

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Remedies for nasal stuffiness often contain which one of the following drugs?
A. Salbutamol
B. Atropine
C. Adrenaline
D. Noradrenaline
E. Xylometazoline
F. Phenylephrine

E. Xylometazoline
F. Phenylephrine

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A 62yo rodeo star was admitted to hospital with cellulitis of his left leg. The man had a previous reaction to penicillin documented. He told medical staff that he had previously had a rash to penicillin and was told never to have it again. The junior doctor decides to give flucloxacillin, and immediately the man develops itching around the mouth, and complains that he cannot breathe. What is the condition, and what drug should be given and how?
A. Minor allergic reaction, salbutamol inhaled
B. Minor allergic reaction, reassure and give oxygen via nasal prongs
C. Anaphylaxis, salbutamol IV
D. Anaphylaxis, adrenaline IM
E. Anaphylaxis, adrenaline IV

Anaphylaxis, adrenaline IM
0.5mg ( 1:1000 0.5ml)

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Why does the total concentration of phenytoin drop in nephrotic syndrome?

Reduced plasma protein bound fraction

(NB we aim for lower conc because the free/active component will be higher.)

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Phenytoin levels increase disproportionately to amount given. Why is this?

Zero order kinetics - can only eliminate a certain amount per unit time, compared to first order kinetics.

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Oldish lady with ?delirium. Urine dipstick shows blood, nitrates and protein present. What medication is most likely to cause/contribute?

Oxybutynin - antagonist of ACh on bladder to relax the bladder and stop overactivity.

Urinary retention (post-renal obstructive as bladder not emptying).
+ confusion (ACh effects)

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Person with sepsis treated with gentamicin, after 5 days the gentamicin levels increase with no dosing change – cause?
- Decreased VD
- Decreased clearance
- Increased VD
- Decreased cmax
- Increased cmax

Sepsis =endothelial damage, increased permeability therefore higher VD. Now he is post-sepsis = decreased VD

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Dude with UC on sulphasalazine develops jaundice and pruritis. Which process has been disrupted?

Bile canaliculi get fucked

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Some guy on ACEI and levothyroxine presents with confusion, lack of appetite, fatigue. Low sodium and low TSH. What’s the cause?
- ACEI?
- Indapamide
- oxybutynin
- allopurinol

The most common cause of hypoNa via drug = thiazide diuretics.

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How does adrenaline work in cardiac arrest?
a) Increase myocardial contractility
b) Change from asystole to VF
c) Increase TPR to increase blood flow to brain and kidneys
d) Improve aortic root pressure to make compressions pmp more blood
e) Making the VF coarser so will cardiovert better

Change from asystole to VF

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Someone with Listeria (brainstem encephalitis?). What antibiotic do you add to gentamicin?
a. Azithromycin
b. Metronidazole
c. Erythromycin
d. Flucloxacillin
e. Other antibiotics
f. Ampicillin

Ampicillin

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Someone with what sounded like BPD took an overdose 3 days ago. Now they have jaundice and tender R hypochondrium and oliguria. What did they take?

Paracetamol likely - liver injury

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Guy started on new hypertensive medication, Hx gout, comes in with tender red MTP joint, which drug?
Thiazide
Loop diuretic
ACE-i

Thiazide

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Dude overdosed on Verapamil. ECG shows second degree Wenckebach heart block, HR 45 and feeling dizzy. Management?
Calcium
Activated charcoal
Adrenaline
Atropine

parenteral administration of calcium injection (calcium chloride) solution.

CALCIUM IS THE ANSWER.

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Some guy came in drowsy but could respond to verbal cues. Took 10 of sertraline 50mg tablets and 5 of diazepam? It was 5 x 5mg diazepam) 25mg tablets 12 hours ago. Obs was normal, drowsy but rousable. He’s currently under observation. What would be the most appropriate treatment be?
No specific treatments
NAC
Naloxone
Flumazenil

No specific treatments. He is rousable.

Benzos actually help with serotonin syndrome.

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Boy had antibiotics for osteomyelitis. Now comes back with diarrhea. Colon had yellow like necrotic plaques. What do you give him?
a. Miconazole
b. Vancomycin
c. Erythromycin

This is C. diff pseudomembranous colitis. Treat with vancomycin.

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Recently started taking St John’s Wort for low mood. Also on Warfarin. INR went from 2 to 1.3.

Increased metabolism, SJW is an enzyme inducer.

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Someone takes BDZ and promethazine. Nystagmus and slurred speech. Vitals ok. Responding to questions. What treatment?

No active management required +5

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Child/toddler with ingestion of paracetamol (quite a bit of liquid paracetamol) arrive at ED 3hrs after, blood tests show toxic levels of paracetamol - treatment?

NAC

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Person who drinks grapefruit juice and has elevated CK/rhabdo what drug?

simvastatin

Septic guy, not improving. Over days his gentamycin levels go up. why?

Decreased clearance.

20. What is important for establishing maintenance dose of digoxin · Renal clearance · Half life · Ideal body weight · Actual body weight

Renal clearance half life determines dose frequency, not amount.

32. What drug is causing this patient’s dry cough (and angioedema? Think it was just dry cough without a prior history of asthma) a. Ace inhibitor (ending in -pril) +33 (Cilazapril) b. Metoprolol c. lots of other drugs

ACE-inhib

Patient with multiple comorbidities. Severely bradycardic was it A fib with ventricular rate of 40bpm? +2 (hx of worsening hf and renal disease?? +1 epilepsy), what drug have they taken too much off? They also had nausea, vomiting and headache i think a. Digoxin b. Phenytoin c. Fluoxetine d. Valproate e. Metoprolol f. Simvastatin g. Lots of things

Digoxin

Man with history of penicillin allergy, got a red rash over his body, including his face, 6 hours after a dose of penicillin was given. What is the best feature to determine the type of drug reaction? (repeat q) a. Time since onset b. Widespread distribution c. Face involvement d. Pruritus e. Red lesions?

Time since onset

1. Piano teacher lady on lithium for bipolar for 6 mths. Develops mild tremor at rest which worsens with activity. Best initial management? a. Measure serum Lithium level b. Neurology referral c. Other options d. Give benzotropine e. Give propanol

Measure serum Lithium level Could very well be the typical normal mild tremor that is common at therapeutic range.

atient had a GI surgery, was on three antibiotics previously including metronidazole. About to be discharged. Had a bout of diarrhoea ~3 days ago, symptom free now. The lab tells you he is positive for c. diff. What now a. Oral metronidazole b. IV metronidazole c. Vancomycin 2 days d. Vancomycin 5 days e. No further treatment f. Vancomycin 2 weeks

No further treatment. He is asymptomatic.

Patient with COPD on some medication already I think, started to have more exacerbations but deemed not to be infective exacerbation. What additional medication should he be put on? (repeat q) a. LAMA b. Some other options

LAMA, you don't use steroids in COPD.

Person on heaps of medications including enalapril and spironolactone, what will monitoring pick up?

Hyperkalemia

Woman with hx of deliberate self-harm presents with jaundice & RUQ pain? + other symptoms OD 3 days ago. History of self harm and depression. What causative agent?

Paracetamol

Pt post MI,has asthma controlled with beta agonist, which drug shouldn't be given to Him Statin, ACE inhibitor, metoprolol, CCB

Metoprolol - bronchoconstriction

15yo girl gets raised rash after eating strawberries what can you give her antihistamine H1, antihistamine H2 (ranitidine), antihistamine H1 and H2, adrenaline, steroids

H1 = antihistamine for allergy H2 = proton pump inhibitor Give just H1

Angiotensin 2 receptor blockers act on what in the kidney Block aldosterone action, block ADH action, block secretion of Na in distal, block reabsorption of Na in proximal convoluted tubule

block reabsorption of Na in proximal convoluted tubule

Enteracept MOA

TNF inhibitor

First line treatment of pseudomembranous colitis in children

If mild - metronidazole If severe - Vancomycin (confirmation of pseudomembranous colitis on colonscopy is severe)

drug that makes Reynolds phenomenon worse?

Beta-blocker

Patient on 2 meds for CHF and SOB, hyponatremic, cause

Bendroflumethazide

Patient with post op temp 39.4 with trismus on intubation,

Malignant hyperthermia, give dantrolene

metformin interaction with digoxin

? lactic acidosis ?nzf says no interaction

Patient losing color vision

Digoxin toxicity

Girl comes to ED, friend says she swallowed 10 tabs with alcohol, unconscious, can be aroused

?ecstasy/methadone

Young adult who is known to be on treatment for epilepsy present with ataxia, ((_) (_) suspected phenytoin toxicity, treatment

If <4 hours à activated charcoal If >4 hours à supportive management

Overdosed on temazepam and promethazine. What do you give her?

Conservative management

Person taking ACEi, metoprolol, bendrofluazide, aspirin, has chronic renal failure. What would regular blood tests most likely help in preventing?

Hypokalemia.

Withdrawal with respiratory depression, bradycardia and hypotension

Methadone

Phenytoin treatment of man on 400mg in therapeutic range, he has a seizure, increased to 500mg but now above the therapeutic window. Why is there no further benefit?

Enzyme saturation, first order kinetics.

Dude broke into veterinary clinic took a lot of drugs. Found comatose after having a generalised seizure. What drug is it most likely to be?

Theophyline overdose 4hrs ago

Either nothing or activated charcoal, especially if modified release tablet.

Mechanism of naltrexone in alcohol dependence treatment

Opioid receptor antagonist

Old woman living in damp house presenting with confusion, skin is very pink most likely toxicity?

Carbon monoxide --> severe poisoning leads to pink

Dude with anaphylaxis. What do you give him? Adrenaline 0.5 ml 1:1000 IM Variations with 1 mL, 1:10000 or IV

Adrenaline 0.5 ml 1:1000 IM

Man had metformin in past and stopped due to side effect. What is the likely side effect?

GI side effects e.g. diarrhoea

A man (56 years old James boi) who ate a bacon and egg pie, salad with a vinaigrette for lunch 2 hours ago. He also recalls taking 2 Voltaren® tablets 6 hours before now. Has a PMHx of mild asthma. He now has wheeze, puffy face and is itchy, widespread rash. Hypotensive at 90. Best management? a) IV hydrocortisone b) IM adrenaline c) Oral prednisone d) IM promethazine

IM adrenaline

Guy recurrent falls for 6 weeks, no warning. Loss of consciousness a few minutes and with quick recovery- witnessed by neighbour. Bit out of it when wakes up but recovers quickly. Happened quite a few times over last 6 weeks. Started terazosin for BPH 2 months ago. Postural hypotension Arrhythmia Epilepsy Narcolepsy Micturition syncope

Postural hypotension (terazosin - alpha blocker, causes hypotension)