Clinical pharm = Flashcards
drug is most likely to cause impaired glucose tolerance in transplant patients
Tacrolimus
oculogyric crisis Management
Benztropine or procyclidine
Which common heart drug can cause sleep disturbances and nightmares
Beta blockers
mechanism underlying the drug-induced renal injury Of aminoglycosides
Acute tubular necrosis
Mechanism of action of aspirin
non reversible COX 1 and 2 inhibitor
Drug used for uti that can cause pulmonary fibrosis
Nitrofurantoin
Inducers of the P450 system
Inducers of the P450 system include
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
smoking
reduce the effects of drug
Inhibitors of the P450 system
Inhibitors of the P450 system include
antibiotics: ciprofloxacin, erythromycin
isoniazid
sodium valproate
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
enhances drug effect/ prolongs drug effect
primary constituents of granulomatous structures
macrophages
what cytokine activates macrophages?
Interferon-γ released by Th1 cells activates macrophages
what cytokine is released by macrophages to cause FEVER and neutrophil chemotaxis?
TNF-a
what cytokine is released by macrophages to cause B cell differentation?
Interleukin-6
what cytokine is released by macrophages to cause neutrophil attraction (chemotaxis) to a site of inflammation/infection?
Interleukin-8
Diabetic nephropathy histological findings
Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)
basement membrane thickening, capillary obliteration, mesangial widening.
hyaline arteriosclerosis
amyloidosis nephropathy histological findings
Apple-green birefringence under polarised light
diffuse proliferative glomerulonephritis (often due to SLE) nephropathy histological findings
Wire looping of capillaries in the glomeruli
which diabetic drug can cause B12 deficiency due to impact on gut mobility and absorption?
metformin
effect of cocaine during pregnancy?
induce preterm labour
Parametric tests
Parametric tests:
Student’s t-test - paired or unpaired
Pearson’s product-moment coefficient - correlation
Non-parametric tests
Mann-Whitney U test
compares ordinal, interval, or ratio scales of unpaired data
Wilcoxon signed-rank test
compares two sets of observations on a single sample, e.g. a ‘before’ and ‘after’ test on the same population following an intervention
chi-squared test
used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions
Spearman, Kendall rank - correlation
what are the cellular target options for drugs?
ion channels eg. lidocaine acts on these
G-coupled receptors. eg. adrenoreceptors
when drugs bind it triggers series of reactions –> produce cyclic AMP –> effects
Guanylate cyclase receptors
contain intrinsic enzyme activity
e.g. atrial natriuretic factor, brain natriuretic peptide
tyrosine kinase receptors eg. insulin acts on these
results in phosphorylation reactions which then cause cell growth/ differentiation
nuclear receptors eg. prednisolone, steroids and levothyroxine
they are lipid soluble so can penetrate the membrane to target these receptors and thereby increase/decrease gene expression
significance tests for correlation
parametric (normally distributed): Pearson’s coefficient
non-parametric: Spearman’s coefficient
treatment ethylyene glycol (antifreeze) or methanol poisoning
fomepizole,
Patients with which complement deficiency are most predisposed to disseminated meningococcal infection?
C5-9 deficiency
Patients with which complement deficiency are most predisposed to immune complex deficiencies like SLE, HSP?
C1q, C1rs, C2, C4 deficiency
Patients with which complement deficiency are most predisposed to recurrent bacterial infections?
C3
what cells produce IgE?
plasma cells produce IgE
IgE receptors are found on mast cells
50% of the population are deficient in hepatic N-acetyltransferase
Drugs affected by acetylator status:
isoniazid
procainamide
hydralazine
dapsone
sulfasalazine
therefore increased risk of toxicity
which hypersensitivity reaction is caused by immune complex deposition?
type 3
which hypersensitivity reaction is caused by antibodies binding to an antigen?
type 2
overdose associated with respiratory alkalosis?
salicylate and theophylline overdoses (these are respiratory stimulants)
theophylline –> seizures, hypoK
why do NSAIDs cause UGI bleeds?
depletes mucosal prostaglandin levels –> mucosal injury
How does NMDA cause its effects?
activates serotonin and sympathetic nervous system
SIADH –> hyponatraemia
–> seizures
which HLA is most important in avoiding hyperacute organ transplant rejection?
HLA-C
antibodies in myasthenia gravis vs lambert eaton syndrom
lamber eaten: voltage gated calcium
myasthenia gravis: anti acetylreceptor autoantibodies
distinguishing feature between methanol vs ethylene glycol (antifreeze) overdose/poisoning?
methanol cause vision loss
the most common lipid storage disorde
Gaucher disease
accumulation of glucocerebrosidase in the brain, liver and spleen. Key features include hepatosplenomegaly, aseptic necrosis of the femur
cardiology drug that causes constipation
verapamil
What is the target for rituximab?
Rituximab - CD20 on B cells
what type of receptors are adrenoceptors?
G coupled
lithium tremor trypes
fine = acute toxicity
coarse = chronic use
Standard error of the mean equation
Standard error of the mean = standard deviation / square root (number of patients)
where does cocaine act?
cocaine blocks the uptake of dopamine, noradrenaline and serotonin
mx. benzos
power equation
Power = 1 - the probability of a type II error
Quinine toxicity signs
Quinine toxicity - anti malarial + leg cramps meds
(cinchonism) presents with myriad ECG changes, hypotension, metabolic acidosis, hypoglycaemia and classically tinnitus, flushing and visual disturbances. Flash pulmonary oedema may occur
what is used to demonstrate publication bias in meta-analysis?
funnel plot
symmetrical - unlikely bias
asymmetrical - bias
vitamin B3 (niacin) deficiency
pellagra
dementia, diarrhoea and dermatitis
inheritance of haemophilia
x linked recessive
Causes of drug-induced photosensitivity
thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureasDepolarising neuromuscular blocker
name a depolarising muscle relaxant?
suxamethonium
statins and pregnancy/ conception
statins should be discontinued in women 3 months before conception due to the risk of congenital defects
Drug-induced gingival hyperplasia causes
anticonvulsants, calcium channel blockers, and immunosuppressants.
Quit smoking
NRT or Varenicline or Bupropion
prescription of NRT, varenicline or bupropion should be sufficient to last only until 2 weeks after the target stop date. Normally, this will be after 2 weeks of NRT therapy, and 3-4 weeks for varenicline and bupropion, to allow for the different methods of administration and mode of action.
Varenicline is more effective but caution in self harm/depression
Bupropion increases seizure risk so not for epileptic
Pregnancy - NRT
Shigella mx
Cipro
What drug is celecoxib?
NSAID
Restless legs syndrome -what is the single most important blood test?
ferritin (common cause of RLS)
Ciclosporin + tacrolimus: mechanism of action
Ciclosporin + tacrolimus: inhibit calcineurin thus decreasing IL-2
drugs that cause Liver cirrhosis
methotrexate
methyldopa
amiodarone
Ciclosporin side-effects
which is most common?
everything is increased - fluid, BP, K+, hair, gums, glucose
HTN is most common
Molecular biology techniques
SNOW (South - NOrth - West)
DROP (DNA - RNA - Protein)
ElISA = detect antigens and antibodies
which cardiac drug can cause corneal opacities?
amiodarone
antiepileptic drug most commonly associated with weight gain?
sodium valproate
Psoriasis triggers
The following factors may exacerbate psoriasis:
trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
Drugs which exhibit zero-order kinetics include.
aka. saturation kinetics
phenytoin, alcohol and salicylates, heparin
which diabetes drug causes syndrome of inappropriate ADH
Sulphonylureas
Gingival hyperplasia drugs
phenytoin, ciclosporin, calcium channel blockers and AML
Drugs known to induce Toxic Epidermal Necrolysis
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
