Clinical pharmacology Flashcards by Daniel Sim

Alpha 1 adrenoreceptor function (4)

vasoconstriction
relaxation of GI smooth muscle
salivary secretion
hepatic glycogenolysis

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alpha 2 adrenoreceptor main functions (3)

mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves)
inhibits insulin
platelet aggregation

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Serotonin syndrome Mx

1st - supportive
2nd - Benzodiazepines
3rd - cyproheptadine or chlorpromazine

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Ethelyne glycol toxicity (aka antifreeZe) Mx

Fomepizole

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Haemodialysis drugs that can be cleared (5)

BLAST

Barbituates
Lithium
Alcohol
Salicylates (eg aspirin)
Theophylline

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Quinolones (Ciprofloxacin) side effects (4)

Lowers seizure threshold
Tendon damage
Cartilage damage (Quinolones contraindicated in children)
lengthens QT

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Paracetamol OD liver transplant criteria (4)

Ph < 7.3 (24 hours post ingestion)
Encephalopathy grade 3/ 4
Increased PT >100s
Creatinine >300

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P450 inducers (eg reduce the effects of warfarin = lower INR)

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
spirinolactone

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Inhibitors of the P450 system include (eg increase the effect of warfarin = higher INR)

antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine, omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
Cranberry

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Drug metabolism
phase I: (2)
phase II: (1)

Drug metabolism
phase I: oxidation, reduction, hydrolysis
phase II: conjugation

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oculogyric crisis
features (2)
Causes (3)
Mx (1)

features: upward gaze deviation, restless agitation
causes: metoclopramide, antipsychotics, parkinson’s
Mx - Benztropine, procyclidine

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oculogyric crisis
features (2)
Causes (3)
Mx (1)

features: upward gaze deviation, restless agitation
causes: metoclopramide, antipsychotics, parkinson’s
Mx - Benztropine, procyclidine

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Ketamine MOA

NMDA antagonist

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Agranulocytosis causes (6 types)

Antithyroid drugs - carbimazole, propylthiouracil
Antipsychotics - atypical antipsychotics (CLOZAPINE)
Antiepileptics - carbamazepine
Antibiotics - penicillin, chloramphenicol, co-trimoxazole
Antidepressant - mirtazapine
Cytotoxic drugs - methotrexate

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Side effects of common diabetic medication

Metformin (2)
Sulfonylureas (4)
Glitazones (2)
Gliptins (1)

Metformin - GI s/e, Lactic acidosis
Sulfonylureas - Hypoglycaemia, Increased appetite and weight gain, SIADH, Liver dysfunction (cholestatic)
Glitazones - Weight gain, Fluid retention, Liver dysfunction Fractures
Gliptins - Pancreatitis

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Causes of drug-induced photosensitivity (5)

thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
sulphonylureas

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N-acetylcystiene (NAC) MOA

Replenish Glutathione in liver

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Amiodarone induced thyrotoxicosis Type 1
pathophys
goitre?
Mx

pathophys - excess iodine induced thyroid hormone stimulation
goitre - present
Mx - carbimazole/ perchlorate

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Amiodarone induced thyrotoxicosis Type 2
pathophys
goitre?
Mx

pathophys - amiodarone-related destructive thyroiditis
goitre - absent
Mx - corticosteroids

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HARMFUL medications in pregnancy (5)

Antibiotics - tetracyclines, aminoglycasides, trimethoprim, quinolones
ACEi, ARBs
Statins
Warfarin
Sulfonylurea

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Organophosphate insecticide treatment

atropine

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Indications for haemodialysis in salicylate overdose (5)

serum concentration > 700mg/L
metabolic acidosis resistant to treatment
acute renal failure
pulmonary oedema
seizures
coma

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Ciclosporin and Tacrolimus MOA

inhibit calcineurin thus decreasing IL-2

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Fomepizole (Antidote for ethylene glycol toxicity) MOA

Inhibit alcohol dehydrogenase

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Drugs exhibiting zero-order kinetics (4)

phenytoin salicylates (e.g. high-dose aspirin) heparin ethanol

Adrenaline induces... (glucose, lactate, potassium)

hyperglycemia, hyperlactatemia and hypokalaemia

The following drugs commonly cause urticaria: (4)

aspirin penicillins NSAIDs opiates

Benzodiazepine overdose treatment

Flumazenil

Adrenaline induced ischaemia Mx

phentolamine

Drugs that cause urinary retention (5)

``` TCA e.g. amitriptyline anticholinergics e.g. antipsychotics, antihistamines opioids NSAIDs disopyramide ```

DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome features (4)

extensive skin rash high fever organ involvement (usually liver) eosinophillia

Ciclosporin MOA SE

inhibits calcineurin to reduce IL2 | SE - nephrotoxicity, hepatotoxicity, fluid retention, hypertensionhyperkalaemia

What medication reduces threshold for seizures (thus increasing seizures)

Ciprofloxacin

Lithium toxicity features

Chronic: fine tremor Acute: Coarse tremor

Abx inhibit cell wall formation

penicillin, cephalosporin, vancomycin

Abx inhibit protein synthesis

Erythromycin, chloramphenicol, gentamicin, doxycycline, clindamycin

Abx inhibit DNA synthesis

quinolones (ciprofloxacin)

Abx damage DNA

metronidazole

Abx inhibit folic acid

sulphonamides, trimethoprim

Abx inhibit RNA synthesis

Rifampicin

Causes of raised anion gap

``` lactic acidosis ketoacidosis renal failure (high urate) toxins such as methanol, (antifreeze) ethylene glycol, salicylates ```

Benzodiazepine overdose MxD

Flumazenil

Drugs that cause pulmonary fibrosis

``` amiodarone cytotoxic agents: busulphan, bleomycin anti-rheumatoid drugs: methotrexate, sulfasalazine nitrofurantoin bromocriptine ```

Verapamil SE

constipation heart failure hypotension, bradycardia, flushing

Infliximab MOA

anti-TNF

RItuximab MOA

anti CD-20

Alemtuzumab MOA

anti CD-52

Cetuzimab MOA

EGFR inhibitor

Trastuzumab MOA

HER2/ Neureceptor antagonist

Abciximab MOA

glycoprotein IIb/ IIIa receptor complex

Drugs that cause photo sensitivity

``` Thiazides Amiodarone NSAIDs Tetracycline, sulphonamides, ciprofloxacin Sulphynurea ```

Digoxin MOA

Inhibit Na/K ATPase pump

Statin contraindicated in statins due to risk of

rhabdomyolysis

Mercury overdose features (3)

visual field defects, hearing loss, paraesthesia

Lead poisoning features (3)

abdominal pain, constipation, headaches.

Ethylene Glycol (anti freeze) overdose features (3)

nausea and vomiting, headaches and intoxication before seizures.

Organophosphate (insecticide) poisoning Mx

atropine

Aspirin MOA (2)

Non reversible COX 1 + 2 inhibitor | Thromboxane 2 inhibitor

Pilocarpine MOA

Muscarinic agonist

Local anaesthetic toxicity Mx

Lipid emulsion

Metoclopramide side effects

galactorrhea

Opioid withdrawal features

abdominal pain diarrhoea agitation sweating

Alcohol withdrawal features

hallucinations - visual, tactile, auditory seizures autonomic hyperactivity - sweating, agitation

Theophylline toxicity features

metabolic acidosis | hypokalaemia

carbimazole moa

inhibition of iodinisation of tyrosine

Contraindication to COCP

``` if age >35 + smoking >15/day BP > 160/95 <6 months post partum if breastfeeding Raynauds, SLE VTE Breast Ca Cardiovascular disease ```

Cyclophosphamide SE

urinary frequency | suprapubic pain

Ethambutol toxicity

visual disturbance | high urate

Isoniazide toxicity

hepatic impairment suicidal psychosis

B Blocker OD treatment

1st - Atropine | 2nd - Glucagon

Primaquine MOA

removal of hypnozoites from liver | for vivax + ovale

Raised anion gap (>16) causes

lactic acidosis DKA ureamia Aspirin toxicity

Fungal nail infection Mx

oral terbinafine

salicylate OD features | Mx

F - tinnitus, sweating, dizziness, hyperventilation, resp alkalosis Mx - IV bicarb, haemodialysis (if severe)

Tumour lysis syndrome Features Mx

hypoCa hyperK hyperPhos Mx - pre chemo hydration + allopurinol

isoniazid SE

peripheral neuropathy | Due to Vit B6 (pyridoxine) deficiency

Mycoplasma pneumonia Mx (2)

Doxy | Clarithromycin

Clinical pharmacology Flashcards

(77 cards)