clinical pharm Flashcards
Which drugs inhibit calcineurin?
ciclosporin
tacrolimus
inihibits calcineurin thus decreasing IL-2
how does octreotide work in acute variceal haemorrhage?
It works by reducing splanchnic blood flow thereby decreasing portal pressure which helps to control bleeding from oesophageal and gastric varices.
what are the side effects of trastuzumab?
- flu like symptoms and diarrhoea are common
- cardiotoxicity - more common when anthracyclines have also been used
echo to be done before starting treatment
how does metformin work?
Biguanides such as Metformin act by activating the AMP-activated protein kinase (AMPK), helping cells to respond more effectively to insulin and take in glucose from the blood.
how does sulfonylurea work?
Sulfonylureas bind to and close ATP-sensitive potassium (K-ATP) channels on the cell membrane of pancreatic beta cells, which depolarises the cell by preventing potassium from exiting.
how is cocaine toxicity managed?
chest pain - benzodiazepines + glyceryl trinitrate
hypertension: benzodiazepines + sodium nitroprusside
what is the mode of action of digoxin?
- Decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve
what are the drugs that cause urticaria?
NAPPY
Nsaids, Aspirin, Penicillin , Op(py)iates
what is part of the king’s college hospaital creirta for liver transplantation??
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
- prothrombin time > 100 seconds
- creatinine > 300 µmol/l
- grade III or IV encephalopathy
how does N-Acetylcistein work?
The liver normally conjugates paracetamol with glucuronic acid/sulphate. During an overdose the conjugation system becomes saturated leading to oxidation by P450 mixed function oxidases*. This produces a toxic metabolite (N-acetyl-B-benzoquinone imine)
Normally glutathione acts as a defence mechanism by conjugating with the toxin forming the non-toxic mercapturic acid. If glutathione stores run-out, the toxin forms covalent bonds with cell proteins, denaturing them and leading to cell death. This occurs not only in hepatocytes but also in the renal tubules
what is the tx for tricyclic overdose?
IV bicarbonate
what are the features of tricyclic overdose?
Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.
severe:
arrhythmias
seizures
metabolic acidosis
coma
how does ketamine work?
Ketamine is an NMDA receptor antagonist. It can be used in neuropathic pain poorly responsive to titrated opioids and oral adjuvant analgesics (e.g. antidepressant and/or anticonvulsant) particularly when there is abnormal pain sensitivity (e.g. allodynia, hyperalgesia or hyperpathia).
what are the inhibitors of CYP450?
SICKFACES.com
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluoxetine
Chloramphenicol
Erythromycin
Sulfonamides
Criprofloxacin
Omeprazole
Metronidazole
Grapefruit juice
what are the inducers of CYP450?
BS CRAP GPS (inducers)
Barbiturates
st johns wort
Carbemazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
why does methanol poisoning cause visual problems?
a common complication of methanol poisoning. A metabolite of methanol, formic acid, accumulates in the optic nerve causing visual disturbance and eventually blindness.
what is the tx for methanol poisoning?
fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
how do you differentaite methaemaglobin, CO poisoning and cyanide poisoning?
Methaemaglobin - normal pO2, low SpO2
CO poisoning - low pO2, low or false normal SpO2
Cyanide poisoning - normal pO2 and SpO2
how does cyanide work?
Cyanide inhibits the enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain.
what are the drugs to avoid in renal failure?
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
what drugs cause photosensitivity?
SCANTy clothing causes sunburn
Sulphonamides
Ciprofloxacin
Amiodarone
NSAIDS
TetracYclines/thiazides
drugs that impair glucose tolerance?
TASTINg Sugar( impared glucose tolerance)
Thiazides, Antipsychotics, Steroids, T cell in inhibitors(tacrolimus |&| cyclosporin), interferon alpha, nicotinic acid.
Sugar = impared glucose tolerance
what is the tx for serotonin syndrome?
Cyproheptadine is an H1 and nonspecific 5HT antagonist
how does finasteride work?
inhibitor of 5 alpha-reductase, an enzyme which metabolises testosterone into dihydrotestosterone.
what are drugs that follow zero order kinetics?
zero order kinetics: where the rate of excretion is constant despite changes in plasma concentration, this is due to saturation of the metabolic process
WATT Power
Warfarin
Aspirin/ Alcohol
Theophylline
Tolbutamide
Phenytoin
what is the mx of beta-blocker overdose?
atropine + glucagon
what are the drugs that can be cleared by haemodialysis?
BLAST -
Barbiturate, Lithium, Alcohol, Salicylate, Theophylline.
drugs are cleared by RRT if they
are water-soluble and not highly protein-bound
what other meds can be used in hyperlipidaemia?
statin
ezetimibe - decreases cholestrol absorption in the small intestine (SE: headaches)
Nicotinic acid - decreases heaptic VLDL secretion (flushing, myositis)
Dibrates - agonist of PPAR-alpha therefore increases lipoportein lipase expression - (SE: myositis, pruritus , cholestasis)
what are the drugs that can cause nightmares and sleep disturbance?
Beta blockers
Amiodarone
Monteleukast
Verapamil
Levodopa
Amitryptyline
which drugs levels need to taken at specific times to check levels?
Lithium - take 12 hrs post dose
ciclosporin - trough levels immediately before dose
digoxin - at least 6 hrs post -dose
phenytoin - trough levels immediately before dose - if suspected toxicity or adjustment of phenytoin dose
when do you administer sodium bicarbonate in TCA overdose?
Give sodium bicarbonate (50 ml of 8.4%) if:
-pH <7.1
-QRS >160 ms
-Arrhythmias
-Hypotension
what are the features of quinine overdose?
cinchonism
ECG changes
hypotension
metabolic acidosis
hypoglycaemia
classically tinnitus, flushing and visual disturbance
Flash pulmonary oedema
what can precipitate lithium toxicity?
reanl failure
drugs that affect renal function (diuretics, ACE-i, NSAIDs)
+
metronidazole
what are the features of ethylene glycol toxicity?
Stage 1: symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness
Stage 2: metabolic acidosis with high anion gap and high osmolar gap. Also tachycardia, hypertension
Stage 3: acute kidney injury
what is the typical features of mercury poisoning?
paraesthesia
visual field defects
hearing loss
irritability
renal tubular acidosis
how does cetuximab work?
epidermal growth factor receptor antagonist
what are the drugs that affect the acetylator status?
SHIP; Sulfonamides (including dapsone) Isoniazid Hydralazine Procainamide
what are the side effects of ciclosporin?
Ciclosporin side-effects: everything is increased - fluid, BP, K+, hair, gums, glucose
what are the features of organophosphate poisoning?
everything is wet
SLUD
Salivation
Lacrimation
Urination
Defecation/diarrhoea
small pupils
what is the tx for caustic substance ingestion?
NBM
IV PPI
urgent oesophago-gastroduodenoscopy
which of the medications can precipitate acute intermitted porphyria?
Blood Problems Have A Sneaky Behaviour
Barbiturates
Pill- OCP
Halothane
Alcohol
Sulphonamides
Benzodiazepines
