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MRCP Part 1 > Clinical Pharmacology and Therapeutics > Flashcards

Clinical Pharmacology and Therapeutics Flashcards

1
Q

What are two side effects of dopamine receptor agonists?

A

Nausea/vomiting
Postural hypotension
Hallucinations
Daytime somnolence

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2
Q

What factors increase the risk of developing hepatotoxicity following a paracetamol overdose?

A

Patients taking liver enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St. John’s Wort)

Malnourished patients (ex. anorexia nervosa) or patients who have not eaten for a few days

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3
Q

List three side effects of amiodarone.

A 
Corneal microdepositis 
Hyper/hypo-thyroidism 
Pneumonitis 
Pulmonary fibrossis 
Hepatotoxicity
Photosensitivity
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4
Q

What visual disturbances does sildenafil cause?

A

Blue tinge to vision and non-arteriti anterior ischemic neuropathy

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5
Q

List two side effects of rifampicin.

A

Liver enzyme inducer
Hepatitis
Orange secretions
Flu-like symptoms

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6
Q

List two side effects of isoniazid.

A

Peripheral neuropathy
Hepatitis
Agranulocytosis
Liver enzyme inhibitor

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7
Q

List two side effects of pyrazinamide.

A

Gout
Arthralgia
Myalgia
Hepatitis

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8
Q

What visual disturbances are associated with ethambutol?

A

Optic neuritis

Restriction of visual field

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9
Q

List three drugs associated with drug-induced thrombocytopenia.

A

Quinine
Abciximab
NSAIDs
Furosemide
Antibiotics: penicillins, sulphonamides, rifampicin
Anticonvulsants: carbamazepine, valproate
Heparin

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10
Q

List three potential side effects of anticholinergics.

A 
Dry mouth 
Blurred vision 
Urinary retention 
Constipation 
Palpitations 
Tachycardia
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11
Q

What is the MOA of heparin?

A

Activates antithrombin III. Standard heparin then forms a complex that inhibits thrombin and factors Xa, IXa, Xia, and XIIa. LMWH then forms a complex that inhibits factor Xa.

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12
Q

What are criteria for liver transplantation following a paracetamol overdose?

A

Arterial pH <7.3 24 hours after ingestion

OR

all of the following: prothrombin time > 100 seconds, creatinine > 300 micromol/L, and grade III or IV encephalopathy

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13
Q

How is a beta-blocker overdose managed?

A

If bradycardic, then atropine. If resistent, glucagon may be used.

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14
Q

List three side effects of tamoxifen.

A

Menstrual disturbance: vaginal bleeding, amenorrhea

Hot flushes

VTE

Endometrial cancer

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15
Q

List notable inducers of the cytochrome P450 system.

A 
Antiepileptics: phenytoin, carbamazepine 
Barbiturates: phenobarbitone 
Rifampicin 
St. John's Wort 
Chronic alcohol intake 
Griseofulvin 
Smoking
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16
Q

List notable inhibitors of the cytochrome P450 system.

A 
Antibiotics: ciprofloaxacin, erythromycin 
Isoniazid 
Cimetidine, omeprazole 
Amiodarone 
Allopurinol
Imidazoles: ketoconazole, fluconazole 
SSRIs: fluoxetine, sertraline 
Ritonavir 
Sodium valproate
Acute alcohol intake 
Quinupristin
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17
Q

What is the management of cocaine toxicity?

A

Benzodiazepines
If chest pain, add glyceryl trinitrate.
If hypertension, add sodium nitroprusside.

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18
Q

What are features of organophosphate insecticide poisoning?

A 
Salivation
Lacrimation 
Urinartion 
Defecation/diarrhea 
Cardiovascular: hypotension, bradycardia 
Small pupils 
Muscle fasciculation

DUMBBELSS - diarrhea, urination, miosis, bronchospasm, bradycardia, emesis, lacrimation, sweating, salivation

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19
Q

What is the management of organophosphate insectide poisoning?

A

Atropine - reverses muscarinic effects and crosses BBB

Pralidoxime - reactives AChE and has both muscarinic and nicotinic effects, cannot cross the BBB

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20
Q

What is the notable side effect of anthracyclines (doxorubicin, daunorubicin)?

A

Cardiotoxicity

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21
Q

What is the notable side effect of bleomycin?

A

Interstitial pulmonary fibrosis

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22
Q

What is the notable side effect of cisplatin?

A

Mg wasting

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23
Q

What is the most notable side effect of cyclophosphamide?

A

Hemorrhagic cystitis

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24
Q

What is the notable side effect of vincristine?

A

Peripheral neuropathy, SIADH, hyponatremia

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25
Q

What are common drugs that cause nephrogenic DI?

A

Demeocycline, lithium, amphotericin, glibenclamide

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26
Q

How is a CCB overdose managed?

A

IV insulin

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27
Q

How is a diethylene glycol overdose managed?

A

Fomepizole or ethanol (inhibit alcohol dehydrogenase)

Hemodialysis if severe

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28
Q

What is the management of lithium toxicity?

A

If mild, symptomatic and volume resuscitation with normal saline.
If severe, hemodialysis.

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29
Q

How is an aspirin overdose managed?

A

Multdose activated charcoal. Consider hemodialysis and IV sodium bicarbonate if severe.

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30
Q

What medications are contraindicated with sildenafil?

A

Nitric oxide or nitrous vasodilators

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31
Q

What are the features of lead poisoning?

A 
Abdominal pain 
Basophilic stippling of RBCs
Anemia
Motor peripheral neuropathy 
Interstitial nephritis 
Gingival markings (Burton's lines, blue) 
Lead lines on long bones
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32
Q

What is the management of tricyclic poisoning?

A

IV sodium bicarbonate

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33
Q

What are the signs and symptoms of digoxin toxicity?

A

Anorexia, nausea, xanthopsia, bradyarrythmia

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34
Q

What are the signs of paracetamol overdose?

A

Nausea, vomiting

Right subcostal pain - may lead to encephalopathy, hypoglycemia, hemorrhage, cerebral edema, death

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35
Q

What are the features of aspirin overdose?

A

Hyperventilation, tinnitus, deafness, vasodilation, sweating, coma

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36
Q

What are the features of tricyclic antidepressant overdose?

A

Dry mouth, seizures, coma, cardiac conduction defects and arrythmias, hypothermia, hypotension, hyperreflexia, respiratory failure, dilated pupils, urinary retention, metabolic acidosis, delirium

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37
Q

What are the features of SSRI overdose?

A

Nausea, vomiting, agitation, tremor, nystagmus, drowsiness, sinus tachycardia, convulsons

Serotoning syndrome

Hyperthermia, rhabdomyolysis, renal failure, and coagulation deficiences

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38
Q

What are the features of beta blocker overdose?

A

Lightheadness, syncope, bradycardia, hypotension, precipitation/exacerbation of heart failure

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39
Q

What are the features of CCB overdose?

A

Nausea, vomiting, agitation, confusion, dizziness, hyperglycemia, coma

Dihydropyridine CCB: peripheral vasodilation, hypotension

Verapamil/diltiazem: arrythmias including complete heart block and asystole

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40
Q

What is the management of aspirin poisoning?

A

Activated charcoal can be givin within one hour of ingesting the overdose

IV sodium bicarbonate may be given (check K concentration prior)

Hemodialysis for severe poisoning

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41
Q

What is the management of aspirin poisoning?

A

Activated charcoal can be givin within one hour of ingesting the overdose

IV sodium bicarbonate may be given (check K concentration prior)

Hemodialysis for severe poisoning

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42
Q

What is the management of paracetamol overdose?

A

Staggered: give NAC immediately

Single: measure paracetamol levels 4 hours after ingestion to determine if NAC needs to be given

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43
Q

What is the management of TCA overdose?

A

Supportive measures

Activated charcoal if given within 1 hour of overdose

IV sodium bicarbonate

IV lorazepam or diazepam for convulsions or sedation

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44
Q

What is the management of SSRI overdose?

A

Supportive

Activated charcoal within one hour of ingestion

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45
Q

What is the management of beta-blocker overdose?

A

Activated charcoal can be considered if the patient presents within 1 hour of ingestion

IV glucagon/severe cases can use IV insulin and glucose

IV sodium bicarbonate for correction of metabolic acidosis

IV atropine for bradycardia

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46
Q

What is the management of CCB overdose?

A

Consider activated charcoal if the patient presents within 1 hour of overdose

Calcium chlorie or calcium gluconate

Atropine for bradycardia

Severe cases: IV insulin and glucose infusion

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47
Q

What are the features of iron overdose?

A

Nausea, vomiting, diarrhoea, abdominal pain, haematemesis, and rectal bleeding. Hypotension and hepatocellular necrosis can occur later. If severe poisoning: coma and shock.

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48
Q

What are the features of lithium toxicity?

A

Initially, apathy and restlessness followed by vomiting, diarrhoea, ataxia, tremor, weakness, dysarthria, and muscle twitching. If severe poisoning: electrolyte imbalance, dehydration, convulsions, renal failure, hypotension and coma.

Features of toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
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49
Q

What is the management of iron salt poisoning?

A

Desferrioxamine mesilate (chelation)

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50
Q

What is the management of lithium poisoning?

A

Supportive

Hemodialysis if severe

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51
Q

What are the features of theophylline toxicity?

A

Severe vomiting, restlessness, agitation, dilated pupils, hyperglycaemia and tachycardia. More serious effects include haematemesis, seizures and arrhythmias (supraventricular and ventricular). Hypokalaemia can develop quickly.

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52
Q

What is the management of theophylline overdose?

A

Repeated doses of activated charcoal

Ondansetron, IV potassium chloride, and IV lorazepam/diazepam as needed

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53
Q

What are the features of benzodiazepine overdose?

A

Drowsiness, dysarthria, ataxia, and nystagmus. Respiratory depression and coma can also occur.

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54
Q

What is the management of benzodiazepine overdose?

A

Activated charcoal within 1 hour of ingesting

Flumazenil

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55
Q

What are the features of phenothiazine overdose?

A

Sinus tachycardia, arrhythmias, hypothermia, hypotension, reduced consciousness and respiratory depression. Dystonic reactions may be seen with therapeutic doses. Seizures in severe cases.

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56
Q

What is the management of a phenothiazine overdose?

A

Treat dystonic reactions with procyclidine hydrochloride or diazepam

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57
Q

What are the features of amphetamine overdose?

A

Initially excessive activity, wakefulness, hallucinations, paranoia and hypertension. Later there may be convulsions, hyperthermia, exhaustion and coma.

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58
Q

What is the management of amphetamine overdose?

A

Diazepam/lorazepam

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59
Q

What are the features of cocaine overdose?

A

Agitation, hypertension, tachycardia, dilated pupils, hallucinations, hyperthermia, hypertonia and hyperreflexia and cardiac effects such as chest pain, arrhythmias, myocardial infarction.

Ischemic colitis, metabolic acidosis, rhabdomyolysis

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60
Q

What is the management of cocaine overdose?

A

IV diazepam

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61
Q

What are the features of opioid overdose?

A

Drowsiness, coma, respiratory depression, pinpoint pupils

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62
Q

What is the management of opiate overdose?

A

Naloxone hydrochloride

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63
Q

What are the features of ecstasy overdose?

A

Delirium, coma, hyperthermia, rhabdomyolysis, acute renal failure, acute hepatitis, disseminated intravascular coagulation, adult respiratory distress syndrome, hyperreflexia, hypotension and intracerebral haemorrhage; hyponatraemia, convulsions, ventricular arrhythmias, delirium, coma

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64
Q

What is the management of ecstasy overdose?

A

Supportive
Diazepam
Danrtrolene for hyperthermia

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65
Q

What is the treatment of methemoglobinemia?

A

Methylthioninium chloride

Methylene blue

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66
Q

What is the management of cyanide poisoning?

A

Dicobalt edetate

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67
Q

What is the management of ethylene glycol and methanol poisoning?

A

Fomepizole

If needed, ethanol

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68
Q

What is the management of carbon monoxide poisoning?

A

High flow oxygen

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69
Q

What are the common agents causing anticholinergic poisoning?

A

Antihistamines, tricyclic antidepressants, carbamazepine, phenothiazines.

70
Q

What are the features of anticholinergic poisoning?

A

Tachycardia, hyperthermia, dilated pupils, warm and dry skin, urinary retention, agitation.

71
Q

What are the common agents causing cholinergic poisoning?

A

Carbamates, organophosphates insecticines, some mushrooms.

72
Q

What are the features of cholinergic poisoning?

A

Salivation, lacrimation, urination, diarrhoea, bronchorrhoea, bronchospasm, bradycardia, vomiting

73
Q

What are the common agents causing hallucinogenic poisoning?

A

Amphetamines, cocaine, MDMA

74
Q

What are the features of hallucinogenic poisoning?

A

Hallucinations, panic, seizures, hypertension, tachycardia, tachypnoea

75
Q

What are the common agents causing opioid poisoning?

A

Morphine, codeine, methadone

76
Q

What are the features of opioid poisoning?

A

Hypoventilation, hypotension, miosis, sedation, bradycardia.

77
Q

What are common agents causing sedative/hypnotic poisoning?

A

Anticonvulsants, benzodiazepines, ethanol

78
Q

What are the features of sedative/hypnotic poisoning?

A

Ataxia, blurred vision, sedation, hallucinations, slurred speech, nystagmus

79
Q

What are the common features of sympathomimetic poisoning?

A

Amphetamines, cocaine, MDMA

80
Q

What are the features of sympathomimetic poisoning?

A

Tachycardia, hypertension, mydriasis, agitation, seizures, hyperthermia, sweating

81
Q

What are some potential side effects of corticosteroids?

A 
Increased appetite potentially leading to weight gain
Acne
Thinned skin that bruises easily 
Increased risk of infections 
Mood changes, mood swings, and depression
Diabetes 
High blood pressure 
Osteoporosis 
Withdrawal
82
Q

How are corticosteroids stopped?

A

Gradual dose reduction alongside adrenal tests

83
Q

What bone protection is offered alongside steroid treatment?

A

Oral bisphosphonates - alendondronic acid, risedronate sodium

84
Q

What is the recommended dose and strength of adrenaline in anaphylaxis?

A

0.5ml in 1:1,000 IM

85
Q

What is the recommended dose and strength of adrenaline in cardiac arrest?

A

10ml 1:10,000 IV or 1ml 1:1,000 IV

86
Q

What is the management of accidental local injection of adrenaline?

A

Loca infiltration of phentolamine

87
Q

What are methods to improve alcohol abstinence?

A

Disulfram

Acamprosate

88
Q

Which classes of antibiotics inhibit cell wall formation?

A

Peptidoglycan cross-linking: penicillins, cephalosporins, carbopenams

Peptidoglycan synthesis: glycopeptides

89
Q

Which classes of antibiotics inhibit protein synthesis?

A

50s subunit: macrolides, chloramphenicol, clindamycin, linezolid, streptogrammins

30s subunit: aminoglycosides, tetracyclines

90
Q

Which class of antibiotic inhibits DNA synthesis?

A

Quinolones

91
Q

Which class of antibiotics damage DNA?

A

Metronidazole

92
Q

Which classes of antibiotics inhibit folic acid formation?

A

Sulphonamides

Trimethoprim

93
Q

Which class of antibiotic inhibits RNA synthesis?

A

Rifampicin

94
Q

What is the MOA of aspirin?

A

Blocks COX-1 and COX-2, blocking thromboxane A2 formation

95
Q

What are the features of carbon monoxide toxicity?

A 
Headache (most common)
Nausea and vomiting 
Vertigo 
Confusion
Subjective weakness 
Severe toxicity: pink skin and mucosae, hyperpyrexia, arrythmias, extrapyramidal features, coma, death
High carboxyhemoglobin levels 
Bilateral globus pallidus lesions
96
Q

What is the management of carbon monoxide poisoning?

A

100% high flow oxygen via non-rebreather mask

Consider hyperbaric oxygen

97
Q

What is the MOA of ciclosporin and tacrolimus?

A

Inhibits calcineurin, reducing IL-2 release

98
Q

What are side-effects of ciclosporin?

A 
Nephrotoxicity 
Hepatotoxicity 
Fluid retention
Hypertension
Hyperkalemia 
Hypertrichosis 
Gingival hyperplasia 
Tremor
Impaired glucose tolerance 
Hyperlipidemia 
Increased susceptibility to severe infection
99
Q

What is the management of cocaine toxicity?

A

Benzodiazepines

100
Q

What is the MOA of cyanide poisoning?

A

Inhibition of enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain

101
Q

What is the presentation of cyanide poisoning?

A

‘classical’ features: brick-red skin, smell of bitter almonds
lactic acidosis with arteriovenous oxygen difference
acute: hypoxia, hypotension, headache, confusion
chronic: ataxia, peripheral neuropathy, dermatitis

102
Q

What is the management of cyanide poisoning?

A

supportive measures: 100% oxygen
definitive: hydroxocobalamin (intravenously), also combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)

103
Q

What are the features of digoxin toxicity?

A

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

104
Q

What is the management of digoxin toxicity?

A

Digibind
correct arrhythmias
monitor potassium

105
Q

List three drugs that cause agranulocytosis.

A

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

106
Q

List two drugs that commonly cause urticaria.

A

aspirin
penicillins
NSAIDs
opiates

107
Q

List three drugs that impair glucose tolerance

A 
thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics
108
Q

List three drugs that cause thrombocytopenia.

A

quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

109
Q

List three drugs that cause urinary retention.

A

tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide

110
Q

List three drugs that cause lung fibrosis.

A

amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

111
Q

List three drugs that cause ocular problems

A

Cataracts - steroids
Corneal opacities - amiodarone, indomethacin
Optic neuritis - ethambutol, amiodarone, metronidazole
Retinopathy - chloroquine, quinine
Sildenafil - blue discoloration, non-arteritic anterior ischemic neuropathy

112
Q

List three drugs that cause photosensitivity.

A 
thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas
113
Q

When are gentamicin levels monitored?

A

Peak (1 hour after administration)

Trough (just before next dose)

114
Q

What drugs can be cleared with hemodialysis?

A 
Barbiturate
Lithium
Alcohol (inc methanol, ethylene glycol)
Salicylates
Theophyllines (charcoal haemoperfusion is preferable)
115
Q

Against what do antibodies form in heparin-induced thrombocytopenia?

A

Complexes of platelet factor 4 and heparin

116
Q

What antibiotics are contraindicated with statins?

A

Macrolides (erythromycin, clarithromycin, azithromycin)

Increased risk of myopathy and rhabdomyolysis

116
Q

What antibiotics are contraindicated with statins?

A

Macrolides (erythromycin, clarithromycin, azithromycin)

Increased risk of myopathy and rhabdomyolysis

117
Q

What is the MOA of metformin?

A

acts by activation of the AMP-activated protein kinase (AMPK)
increases insulin sensitivity
decreases hepatic gluconeogenesis
may also reduce gastrointestinal absorption of carbohydrates

118
Q

What are the common side effects of metformin?

A

GI upset - nausea, anorexia, diarrhea
Reduced B12 absorption
Lactic acidosis

119
Q

How is metformin started?

A

metformin should be titrated up slowly to reduce the incidence of gastrointestinal side-effects

if patients develop unacceptable side-effects then modified-release metformin should be considered

120
Q

What is the management of methanol poisoning?

A

fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
haemodialysis
cofactor therapy with folinic acid to reduce ophthalmological complications

121
Q

What is the target of infliximab?

A

Anti-TNF

122
Q

What is the target of rituximab?

A

anti-CD20

123
Q

What is the target of cetuximab?

A

Epidermal growth factor receptor antagonist

124
Q

What is the target of trastuzumab?

A

HER2/neu receptor antagonist

125
Q

What is the target of alemtuzumab?

A

anti-CD52

126
Q

What is the target of abciximab?

A

Glycoprotein IIb/IIIa receptor antagonist

127
Q

What is the target of OKT3?

A

anti-CD3

128
Q

What is the only depolarizing NMJ blocker?

A

Suxamethonium

129
Q

What are the three non-depolarizing NMJ blockers?

A

Atracurium
Vecuronium
Pancuronium

130
Q

How are non-depolarizing NMJ blockers reversed?

A

Neostigmine

131
Q

What is the management for salicylate poisoning?

A

urinary alkalinization with IV bicarbonate

haemodialysis

132
Q

What is the management of a benzodiazepine overdose?

A

Flumazenil

133
Q

What is the management of warfarin overdose?

A

Vitamin K

Prothrombin complex

134
Q

What is the management of a heparin overdose?

A

Protamine sulphate

135
Q

What do phase I and phase II drug reactions involve?

A

Phase I - oxidation, reduction, hydrolysis

Phase II - conjugation

136
Q

What is the MOA of amiloride?

A

blocks the epithelial sodium channel in the distal convoluted tubule

137
Q

What is the MOA of spironolactone?

A

acts in the cortical collecting duct

138
Q

List two drugs that may exacerbate heart failure.

A 
thiazolidinediones
verapamil 
NSAIDs 
glucocorticoids 
class I antiarrythmics - flecainide
139
Q

What drugs should be avoided in renal failure?

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

140
Q

List three drugs to avoid in pregnancy.

A 
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones: the BNF advises to avoid due to arthropathy in some animal studies
ACE inhibitors, angiotensin II receptor antagonists
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents
anti-epileptics
141
Q

What is the MOA of quinolones?

A

inhibit topoisomerase II (DNA gyrase) and topoisomerase IV

142
Q

What are the ADRs of quinolones?

A

lower seizure threshold
tendon damage/rupture
cartilage damage
QT prolongation

143
Q

What are the contraindications of quinolones?

A

Pregnancy
Breastfeeding
G6PD

144
Q

What are the features of serotonin syndrome?

A

Neuromuscular excitation - hyperreflexia, myoclonus, rigidity

Autonomic nervous system excitation - hyperthermia, sweating

Altered mental state - confusion

145
Q

What is the management of serotonin syndrome?

A

Supportive
Benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

146
Q

What are common side effects of CCBs?

A

• Headache
• Flushing
• Ankle oedema

Verapamil also commonly causes constipation

147
Q

What are common side effects of beta-blockers?

A

• Bronchospasm (especially in asthmatics)
• Fatigue
• Cold peripheries
• Sleep disturbances

148
Q

What are common side effects of nitrates?

A

• Headache
• Postural hypotension
• Tachycardia

149
Q

What are common side effects of nicorandil?

A

• Headache
• Flushing
• Anal ulceration

150
Q

What are common side effects of sulfonylureas?

A

Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)

151
Q

What are common side effects of glitazones?

A

Weight gain
Fluid retention
Liver dysfunction
Fractures

152
Q

What is a common side effect of gliptins?

A

Pancreatitis

153
Q

What are the ADRs of tamoxifen?

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

154
Q

How does the COCP affect cancer risk?

A

reduced risk of ovarian, endometrial - this effect may last for several decades after cessation

increased risk of breast and cervical cancer

155
Q

When should ciclosporin levels be checked?

A

Trough levels immediately before dose

156
Q

When should lithium levels be checked?

A

12 hours post-dose

157
Q

When should digoxin levels be checked?

A

At least 6 hours post dose

158
Q

When should phenytoin levels be checked?

A

Trough levels immediately before dose

159
Q

What is the management of TCA overdose?

A

IV bicarbonate
Arrythmia management (do not give drugs like quinidine, flecainide, amiodarone)
IV lipid emulsion

159
Q

What is the management of TCA overdose?

A

IV bicarbonate
Arrythmia management (do not give drugs like quinidine, flecainide, amiodarone)
IV lipid emulsion

160
Q

What are the features of methanol poisoning?

A

Mydriasis, optic disc hyperemia, confusion, stupor, coma, bradycardia, bradypnea, hypotension, hyporeflexia
Metabolic acidosis with a high anion gap
High osmolar gap

161
Q

What are the features of ethylene glycol poisoning?

A

Acute renal failure - flank pain, oliguria
Hypocalcemia
Tetany
Metabolic acidosis with a high anion gap
High osmolar gap

162
Q

What are the features of mercury poisoning?

A

Neurotoxic symptoms - anxiety, irritability, depression, memory deficits, numbness, tremors

163
Q

What are the features of acute arsenic poisoning?

A

GI symptoms - abdominal pain, nausea, vomiting, diarrhea
Garlic like breath odor
CNS symptoms - drowsiness, confusion, delirium
Cardiac symptoms - prolonged QT interval

164
Q

What are features of chronic arsenic poisoning?

A

Occupational - vineyard work
Increased risk of tumors - lung cancer, SCC, liver angiosarcoma
Mees line

165
Q

What is the management of arsenic poisoning?

A

Children - succimer

Adults - dimercaprol

166
Q

What is the management of lead poisoning?

A

Children - succimer

Adults - dimercaprol or EDTA

167
Q

What is the management of mercury poisoning?

A

Children - succimer

Adults - dimercaprol

168
Q

What are the features of methemoglobinemia?

A

Cyanosis, dyspnea, confusion, drowsiness, seizures, coma, death
Chocolate brown blood
High methemoglobinemia

MRCP Part 1 (2 decks)

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