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MRCP - Passmed > Clinical pharmacology + toxicology > Flashcards

Clinical pharmacology + toxicology Flashcards

1
Q

Features of lithium toxicity?

A

coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

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2
Q

Mx of lithium toxicity?

A

mild-moderate - fluid resus
(monitor Na levels if concern of nephrogenic DI)

severe - haemodialysis may be required

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3
Q

What are some side effects of metformin?

A

GI side effects

Lactic acidosis

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4
Q

What are some side effects associated with sulphonureas?

A

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

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5
Q

What are some side effects associated with Glitazones?

A

Weight gain
Fluid retention + decompensation of HF
Liver dysfunction
Fractures

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6
Q

What are some side effects associated with Gliptins?

A

Pancreatitis

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7
Q

paraesthesia
visual field defects
hearing loss
irritability
renal tubular acidosis

Suggest what type of poisoning?

A

Mercury

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8
Q

Which drugs can cause urinary retention?

A

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

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9
Q

Which drugs can cause lung fibrosis?

A

Amiodarone

Cytotoxic agents - busulphan, bleomycin

anti-rheumatoid drugs - methotrexate, sulfasalazine

Nitrofurantoin

Ergot derived dopamine agonists eg bromocriptine, cabergoline, pergolide

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10
Q

Octreotide MoA

A

Somatostatin analogue

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11
Q

Blood gas findings in ethylene glycol / methanol poisoning?

Mx?

A

Raised anion gap metabolic acidosis w high osmolar gap

Use Fomepizole / ethanol - act as competitive inhibitor of alcohol dehydrogenase

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12
Q

Which CCB can cause constipation?

A

Verapamil

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13
Q

Adverse effects associated with aminoglycoside use? examples? when to avoid?

A

Aminoglycosides like gentamicin can cause:

Irreversible ototoxicity - due to auditory / vestibular nerve damage

Nephrotoxicity secondary to ATN - using furosemide increases this risk

CI in myasthenia gravis

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14
Q

Examples of Quinolones? When are these CI?

A

Examples:
ciprofloxacin
levofloxacin

Contraindications:
Quinolones should generally be avoided in women who are pregnant or breastfeeding
avoid in G6PD - can percipitate haemolytic anaemia

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15
Q

Licenced indications of Botox

A

blepharospasm
hemifacial spasm
focal spasticity including cerebral palsy patients, hand and wrist disability associated with stroke
spasmodic torticollis
severe hyperhidrosis of the axillae
achalasia

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16
Q

Digoxin MoA?

A

Na/K ATPase pump inhibitor

Class II antiarrhytmic also BBs

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17
Q

Adrenaline doses in cardiac arrest and anaphylaxis?

A

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM

cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

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18
Q

Tamoxifen MoA?

Adverse effects?

A

SERM (Selective oEstrogen Receptor Modulator)

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer (can use Raloxifene - pure oestrogen receptor antagonist - lower risk)

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19
Q

What are phase I and phase II reactions in drug metabolism?

A

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

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20
Q

TB drug side effects?

A

Rifampicin = Red/orange body secretions

Isoniazid= Ice causes numbness on the skin = peripheral neuropathy

Pyrazinamide= P looks like a big toe = big painful toe bcz of hyperuricemia = Gout

Ethambutol = Eye = optic neuritis

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21
Q

Metformin MoA?

A

activation of the AMP-activated protein kinase (AMPK)

-> increased insulin sensitivity, decreased hepatic gluconeogenesis + ?reduced GI absorption of carbs

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22
Q

abciximab MoA? use case?

A

glycoprotein IIb/IIIa receptor antagonist

used in prevention of ischaemic events in patients undergoing percutaneous coronary interventions

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23
Q

Adverse effects associated with Quinolones? what are some examples?

A

Examples:
- Levofloxacin
- Ciprofloxacin

Adverse effects:
- Reduces seizure threshold
- Tendon damage inc. rupture
- Cartilage damage in animal models - hence generally avoided in children
- QT prolongation

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24
Q

Abdo pain / rectal bleeding following cocaine ingestion

Diagnosis?

A

Ischaemic colitis

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25
Q

Aspirin MoA?

A

Non-reversible COX 1 + 2 inhibitor

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26
Q

MoA of LMWH?

A

LMWH activates antithrombin III.

This forms a complex that inhibits factor Xa

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27
Q

MoA of Unfractionated heparin?

A

Unfractionated heparin forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa.

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28
Q

Rituximab MoA? Use?

A

MAb against CD20 used in R-CHOP regimen for non-hodgkins lymphoma

Also used in RA

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29
Q

Infliximab MoA? use?

A

Anti-TNFa used in RA and Crohns

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30
Q

Daratumumab MoA? Use?

A

Anti-CD38 used in multiple myeloma

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31
Q

Alemtuzumab MoA? Use?

A

Anti-CD52 used in CLL

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32
Q

Trastuzumab (Herceptin) MoA? Use?

A

Anti-HER2 used in HER2 +ve metastatic breast ca

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33
Q

Class 1a antiarrhytmics and some examples?

Mneumonic

A

“I am Ambivalent about the QUEEn PROofreading my DISsertation”: Class IA antiarrhythmic drugs are QUEEnidine, PROcainamide, DISopyramide.

These are Na channel blockers

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34
Q

Class 1b antiarrhytmics and some examples?

A

“LInDO MEXIco Is the Best”: LIDOcaine and MEXIletine are class IB antiarrhythmic drugs.

Also Na channel blockers

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35
Q

Class 1c antiarrhytmics and some examples?

Mneumonic

A

“I Can’t Fail, Please”: Class IC antiarrhythmics are Flecainide, Propafenone.

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36
Q

Class 3 antiarrhytmics and some examples?

Mneumonic

A

K channel blockers - prolonging cardiac AP and delays refractory period

“I Am Sober, Doctor, for III days”: Ibutilide, Amiodarone, Sotalol, and Dofetilide are class III antiarrhythmic drugs.

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37
Q

Features of organophosphate poisoning? Mneumonic

A

SLUDD

s=salivation
l=lacrimation, low BP, low pluse
u= urination
d=defecation
d=diarrhea, decrease pupil size.

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38
Q

Prognostic factors in Paracetamol Overdose

A

The arterial pH is the single most important prognostic factor ( <7.3 24h post-ingestion)

Others:
- Creatinine >300
- Increased PT time (>100s)
- Grade III or IV encephalopathy

NB these are the indications for liver transplantation (need all 3 others or JUST LOW PH)

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39
Q

MoA of allopurinol?

A

Allopurinol inhibits xanthine oxidase

(which oxidises 6-mercaptopurine into 6-thiouric acid)

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40
Q

TCA overdose with hypotension / widened QRS / VT

Mx?

A

IV bicarb

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41
Q

Which drugs commonly interact with CYP450 inhibitors / inducers?

A

Warfarin the Combined Contraceptive Pill, Theophylline, Corticosteroids, Tricyclics, Pethidine, and Statins.

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42
Q

Which drugs are common CYP450 inducers?

A

CRAP GPS - generally need prolonged exposure

Carbemazepines (+Phenytoin)
Rifampicin
Alcohol - chronic
Phenytoin
Griseofulvin
Phenobarbitone (Barbiturates)
Sulphonylureas + Smoking + St Johns Wort

Reduced drug concentration

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43
Q

Which drugs are common CYP450 inhibitors? effect?

A

SICK FACES.COM

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice - acute (Also amiodarone + allopurinol)
Chloramphenicol
Erythromycin
Sulfonamides (SSRIs too)
Ciprofloxacin
Omeprazole
Metronidazole

Increased drug concentration

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44
Q

Drugs which are known to cause impaired glucose tolerance include:

A

‘STATIN’:

Steroids
Thiazides - Furosemide also but less
Antipsychotics
Tacrolimus/ciclosporin
Interferon-alpha
Nicotinic acid

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45
Q

Pilocarpine MoA?

A

Muscarinic agonist - M1-3 -> induction of parasympathetic action

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46
Q

Which drugs can cause cataracts?

A

steroids

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47
Q

Which drugs can cause corneal opacities?

A

amiodarone
indomethacin

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48
Q

Which drugs can cause optic neuritis?

A

ethambutol
amiodarone
metronidazole

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49
Q

Which drugs can cause retinopathy?

A

chloroquine, quinine

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50
Q

What can happen to the eyes with sildenafil?

A

Blue discolouration
Non-arteritic anterior ischaemic neuropathy

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51
Q

Why can Sodium Bicab be considered in lithium toxicity?

A

Increases urine alkalinity thus promoting lithium excretion

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52
Q

HTN in Lithium patients?

A

ACE-i and ARBs can cause toxicity

CCBs - Diltiazem / Verapamil - increase risk of neurotoxicity

Amlodipine is fine

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53
Q
A
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54
Q

When to give sodium bicarb in mx of TCA overdose?

A

pH <7.1
widened QRS esp >160 ms
Arrhythmias
Hypotension

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55
Q

Example of a1 antagonist?

A

doxasosin

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56
Q

Example of a1a agonist?

A

tamsulosin acts mainly on urogenital tract

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57
Q

Example of a2 antagonist?

A

yohimbine

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58
Q

example of non-selective a antagonist

A

phenoxybenzamine - used be used in peripheral arterial disease

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59
Q

Example of b1 antagonist?

A

Atenolol

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60
Q

Example of non-selective b antagonist?

A

Propanolol

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61
Q

example of a + b mixed antagonists?

A

Carvedilol
Labetalol

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62
Q

confusion, headache, and characteristically cherry-pink mucous membranes

Suggestive of what condition?

A

CO poisoning

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63
Q

How does aspirin achieve antiplatelet effect?

A

Inhibits the production of thromboxane A2 secondary to irreversible inhibition of COX1

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64
Q

How do ciclosporin and tacrolimus work?

A

Inhibit calcineurin in T cells thus decreasing IL-2

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65
Q

Mx of organophosphate poisoning?

A

Atropine

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66
Q

Which drugs commonly cause urticaria?

A

aspirin
penicillins
NSAIDs
opiates

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67
Q

Which medications are best for motion sickness?

A

Motion sickness - hyoscine > cyclizine > promethazine

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68
Q

Ketamine MoA?

A

NMDA receptor antagonist

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69
Q

MoA of finasteride and adverse effects?

A

Finasteride = 5a reductase inhibitor

Adverse:
>impotence
>decrease libido
>ejaculation disorders
>gynaecomastia and breast tenderness

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70
Q

Disadvantages of POP contraceptive?

A

irregular periods: some users may not have periods whilst others may have irregular or light periods. This is the most common adverse effect

increased incidence of functional ovarian cysts

common side-effects include breast tenderness, weight gain, acne and headaches. These symptoms generally subside after the first few months

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71
Q

Licensed indications for Botox?

A

blepharospasm

hemifacial spasm

focal spasticity including cerebral palsy patients, hand and wrist disability associated with stroke

spasmodic torticollis

severe hyperhidrosis of the axillae
achalasia

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72
Q

Management of accidental injection of adrenaline? e.g. resulting in digital ischaemia

A

Local infiltration of phentolamine

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73
Q

Drugs that most commonly cause urticaria?

A

aspirin
penicillins
NSAIDs
opiates

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74
Q

Blood gas in mercury poisoning + why?

A

Hyperchloraemic metabolic acidosis consistent with renal tubular acidosis i

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75
Q

Which abx inhibit protein synthesis by acting on 30s subunit of ribosome?

A

Aminoglycosides - Gentamicin

Tetracyclines - demeclocycline

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76
Q

Which abx inhibits DNA synthesis?

A

quinolones (e.g. ciprofloxacin)

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77
Q

MoA of Metronidazole?

A

Damage DNA

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78
Q

Which abx inhibit folic acid formation

A

Sulphonamides

trimethoprim

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79
Q

Which endocrine med can cause gallstones secondary to biliary stasis?

A

Octreotide - somatostatin analogue

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80
Q

Mx of BB overdose?

A

if bradycardic then atropine

in resistant cases glucagon may be used

81
Q

Mx of lead poisoning?

A

Dimercaprol, calcium edetate

82
Q

Mx of Cyanide poisoning?

A

Hydroxocobalamin;

also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

83
Q

myriad ECG changes, hypotension, metabolic acidosis, hypoglycaemia and classically tinnitus, flushing and visual disturbances. Flash pulmonary oedema may occur

This is seen with which overdose? What are the ECG changes seen?

A

Quinine toxicity - cinchonism

Prolonged QT, QRS which can degenerate into ventricular tachyarrhythmias / fibrillation

84
Q

What is the benefit of humanising antibodies?

A

Decreases immunogenicity of mab

85
Q

Which abx work by inhibiting protein synthesis by acting on 50s subunit of ribosome?

A

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

86
Q

Which medications exhibit saturation kinetics (Zero-order)

A

zero order kinetics-> SHEEP

Salicylates-S
Heparin-HE
Ethanol-E
Phenytoin-P

87
Q

MoA of Cetuximab?

A

Cetuximab - monoclonal antibody against the epidermal growth factor receptor

Used in met colorectal ca + Head and neck ca

88
Q

MoA of heparin induced thrombocytopaenia?

A

antibodies form against complexes of platelet factor 4 (PF4) and heparin

Develops 5-10d of treatment in

This is a pro-thrombotic condition

89
Q

What is the MoA of erythromycin for gastroparesis?

A

Acts as motilin receptor agonist -> promoting gastric emptying

90
Q

What should happen to Metformin during MI and why?

A

Stopped due to risk of lactic acidosis

91
Q

MoA of tacrolimus?

A

Decreases IL2 release via inhibition of calcineurin

92
Q

MoA of fomipezole? When is it used?

A

Competitive inhibitor of alcohol dehydrogenase

Used in preference to alcohol in ethylene glycol poisoning

93
Q

MoA of polyuria in excess alcohol

A

Ethanol reduces the calcium-dependent secretion of anti-diuretic hormone (ADH) by blocking channels in the neurohypophyseal nerve terminal.

94
Q

When is Flecainide CI?

A

should not be used in patients with structural heart disease, such as ischaemic heart disease and chronic heart failure, due to an increased risk of arrhythmia and mortality

95
Q

Uses of octreotide?

A

acute treatment of variceal haemorrhage
acromegaly
carcinoid syndrome
prevent complications following pancreatic surgery
VIPomas
refractory diarrhoea

96
Q

What is MCAT similar to?

A

Amphetamine

97
Q

Abx likely to cause photosensitive rash?

A

Tetracycline

98
Q

What blood test changes can be seen delayed in response to excess paracetamol?

A

Delayed paracetamol nephrotoxicity

99
Q

Which type of abx can cause tendon rupture?

A

Quinolones

100
Q

Mx of Cocaine induced CP / MI?

A

benzodiazepines + glyceryl trinitrate

If MI also PCI

101
Q

Mx of Cocaine induced HTN?

A

benzodiazepines + sodium nitroprusside

102
Q

Mx of oculogyric crisis?

A

cessation of causative medication if possible

intravenous antimuscarinic: benztropine or procyclidine

103
Q

When is it classified as severe lithium toxicity? mx?

A

> 2.5 mmol/L

Haemodialysis

104
Q

What are the side effects of ciclosporin?

A

Ciclosporin side-effects: everything is increased - fluid, BP, K+, hair, gums, glucose, tremor, lipids

Also nephro + hepatotoxicity + severe infection risk

Cause when you cycle it goes up

105
Q

What medication causes blue vision?

A

blue vision: Viagra (‘the blue pill’)

106
Q

What effect can sulphonylureas cause on kidneys?

107
Q

Phenylephrine MoA?

A

a1 agonist

108
Q

Tamsulosin MoA?

A

A-1a antagonist

109
Q

LMWH MoA?

A

Low-molecular weight heparin activates antithrombin III.

Forms a complex that inhibits factor Xa

110
Q

Pilocarpine MoA?

A

Muscarinic receptor agonist

111
Q

Sildenafil MoA?

A

phosphodiesterase type V inhibitor

112
Q

Drugs to avoid in pregnancy?

A

SAFE Moms Take Really Good Care = WIN

Sulphonamides/ Statins
Aminoglycosides/ACE inhibitors
Fluoroquinolones
Erythromycin/Estradiol
Meronidazole
Tetracyclines
Ribavirin
Griseofulvin
Chloramphenicol/Clomiphene citrate
Warfarin
Isoniazid
Nitroimidazole

113
Q

How long to wait between increasing Metformin doses?

A

1 week at least

114
Q

Levothyroxine acts on what receptor?

A

Nuclear receptors

115
Q

Which CCB can cause constipation?

116
Q

How to screen for high risk of allopurinol induced severe cutaneous adverse reactions (SCARs)

A

Screen for HLA-B *5801 allele

NB SCARs include SJS and TEN

117
Q

How to distinguish between TEN and SJS?

A

It is based on body surface affected

< 10% for SJS
> 30% for TEN

118
Q

Mx of CO poisoning?

A

1st 100% high flow o2

2nd Hyperbaric O2 if refractory esp if >25% carboxyHb

119
Q

Local anesthetic toxicity mx?

A

IV 20% lipid emulsion

120
Q

Side effects of BBs?

A
  • Bronchospasm (especially in asthmatics)
  • Fatigue
  • Cold peripheries
  • Sleep disturbances
121
Q

Side effects of nitrates?

A
  • Headache
  • Postural hypotension
  • Tachycardia
122
Q

Side effects of Nicorandil

A
  • Headache
  • Flushing
  • Anal ulceration
123
Q

Which drugs can cause nightmares?

A

MNEMONIC - Nightmares: BAM! … VLAM!:

Beta Blockers;
Amiodarone;
Monteleukast;

Verapamil;
Levodopa;
Amitriptyline;
Morphine.

124
Q

class IV antiarrhytmics MoA + examples?

A

calcium channel blockers

eg Diltiazem + Verapamil

125
Q

How to distinguish between methanol and ethylene glycol poisoning?

A

Methanol = eye signs eg macular oedema, poor pupilary responses, maybe not following gaze / asking for lights to be switched on

126
Q

Name a depolarising NMJ blocker? any interesting facts?

A

Suxamethonium - fastest onset and shortest duration of muscle relaxants

Produces muscle contraction prior to paralysis
Can be used in RSI if non-fasted prior to surgery

127
Q

Name a non-depolarising NMJ blocker? onset? reversal agent

A

AVP

Atracurium, Vecuronium, Pancuronium

1st two = 30-45 mins
3rd = 2-3 mins

Reversal = Neostigmine (only partial action on Pancuronium)

128
Q

Why should hypotonic saline (0.45%) be avoided in paediatrics?

A

Risk of hyponatraemic encephalopathy

129
Q

Blood gas findings and BMs in Quinine toxicity?

A

Metabolic acidosis

Hypoglycaemia

130
Q

What drugs can cause hypomagnesaemia?

A

Diuretics

PPIs

131
Q

What electrolyte disturbances and metabolic disorders can cause hypomagnesaemia?

A

Hypokalaemia
Hypercalcaemia

Gitlemans and Bartters syndromes

132
Q

Effect of cocaine on pregnant women? what else has the same effects?

A

Intrauterine growth retardation
Preterm labour

Smoking also has these same effects

133
Q

Lithium effect on pregnancy?

A

Ebsteins anomaly

134
Q

Effect of certain abx with pregnancy?

A

color change — grey teeth and grey baby syndrome

135
Q

Effect of epilepsy drugs on pregnancy?

A

brain – craniofacial abnormalities and neural tube defects

136
Q

Causes of normal anion gap metabolic acidosis?

A

Causes of NAGMA include (‘ABCD’):
Addison’s
Bicarbonate loss: GI (e.g. diarrhoea) or renal (e.g. renal tubular acidosis)
Chloride excess
Diuretics (e.g. acetazolamide)

137
Q

Causes of raised anion gap metabolic acidosis?

A

Causes of high anion gap metabolic acidosis (HAGMA) include:
Lactate
Toxins (e.g. methanol, paracetamol, propylene glycol)
Ketones
Renal failure

138
Q

The presence of hypokalemia with NAGMA is suggestive of what?

A

Type 1 RTA can be caused by mercury poisoning

139
Q

Mx of serotonin syndrome?

A

supportive including IV fluids
benzodiazepines

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

140
Q

Features of serotonin syndrome?

A

Faster onset v neuroleptic malignant syndrome (hours v hours-days)

Hyperreflexia, clonus and dilated pupils (NM excitation)
Hyperthermia + sweating (autonomic excitation)
Confusion

141
Q

Teicoplanin MoA?

A

Similar to Vanc - glycopeptide abx but longer duration hence OD dosing

inhibit peptidoglycan synthesis

142
Q

Burning plastics, bitter almond smeel and red ashen appearance is suggestive of what type of poisoning? How does this work?

A

Cyanide poisoning - inhibits the enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain

143
Q

Features of chronic cyanide poisoning?

A

chronic: ataxia, peripheral neuropathy, dermatitis

144
Q

Amiloride/ Triamterene MoA? when is it used?

A

blocks the epithelial sodium channel in the distal convoluted tubule

Acts as K sparing diuretic

Used in Liddle’s syndrome (ENaC disorder)

145
Q

What are drug induced causes of thrombocytopaenia?

A

HARDPANS Q(looks a little like a pan?)
- Heparin
- Anticonvulsants: Carbamazepine, Valproate
- Rifampicin
- Diuretics: Furosemide

  • Penicillins
  • Abciximab
  • NSAIDs
  • Sulphonamides
  • Quinine

Hitting a pan hard causes brusing

146
Q

What drugs are affected by acetylator status?

A

If it helps I use the mnemonic HIPS and remember that Tyla (the singer) likes to use her HIPS and has a hip Dip - cause aceTYLAtor

H= Hydralazine
I= Isoniazid
P = Procainamide
S= Sulfasalazine

D = Dapsone

147
Q

Which drugs can percipitate an attack of acute intermitten porphyria

A

Blood Problems Have A Sneaky Behaviour

  • Barbiturates
  • Pill- OCP
  • Halothane
  • Alcohol
  • Sulphonamides
  • Benzodiazepines
148
Q

What is the Wolff-Chaikoff effect? What drug can cause this?

A

Autoregulatory phenomenon where thyroxine formation is inhibited due to high levels of circulating iodide

Amiodarone - can still be continued if this happens

149
Q

What is AIT and describe its features and mx?

A

Amiodarone-induced thyrotoxicosis (AIT) may be divided into two types:

AIT type 1 - Excess iodine-induced thyroid hormone synthesis, goitre present
Mx = Carbimazole / Potassium Perchlorate

AIT type 2 - Amiodarone-related destructive thyroiditis, no goitre
Mx = corticosteroids

150
Q

What is in antifreeze?

A

Ethylene glycol

151
Q

Cardiac features of ethylene glycol toxicity?

A

HTN and tachycardia

152
Q

Products of phase I reactions are typically more lipid soluble - true or false?

A

False - they are more water soluble

153
Q

What are the indications for dopamine agonists? what are the adverse effects?

A

Parkinson’s disease
prolactinoma/galactorrhoea
cyclical breast disease
acromegaly

Adverse effects:
nausea/vomiting
postural hypotension
hallucinations
daytime somnolence

154
Q

What causes QT shortening?

A

Hypercalcaemia,
hypermagnesaemia,
digoxin, or
thyrotoxicosis

155
Q

What causes QT prolongation?

A

A - AntiArrhythmics (Amiodarone, Sotalol, Flecainide)

A - AntiAnginals (Ranolazine)

B - AntiBiotics (Fluoroquinolones, Macrolides, Aminoglycosides)

C - AntiCychotics (Haloperidol, Quetiapine, Risperidone)

D - AntiDepressants (SSRIs, TCAs)

E - AntiEmetics (Ondansetron)

156
Q

What drugs can cause photosensitivity?

A

SCANTy clothing causes sunburn

Sulphonamides
Ciprofloxacin
Amiodarone
NSAIDS
TetracYclines/thiazides

157
Q

Adverse effects associated with trastuzumab (Herceptin)?

A

flu-like symptoms and diarrhoea are common

Cardiotoxicity - echo prior to tx (more common when anthracyclines (-rubicin) have also been used)

158
Q

What are the features of DRESS syndrome?

A

Triad of extensive skin rash, high fever, and organ involvement - can also see eosinophillia

Occuring 2-8w after starting drug

DR E SS = Drug reaction, eosinophillia and systemic sx

159
Q

Features of TCA overdose?

A

Anticholinergic effects
Visual disturbances
Urinary retention
Dry mouth
Constipation

Can’t see, can’t pee, can’t spit, can’t shit

+ QT prolongation

160
Q

When to check levels for:
Ciclosporin
Digoxin
Phenytoin

A

Ciclosporin = trough levels immediately before dose

Digoxin = at least 6 hrs post-dose

Phenytoin = trough levels immediately before dose (if adjustment to dose, suspected toxicity or non-adherence suspected)

161
Q

alcohol dehydrogenase and xanthine oxidase which phase of drug metabolism?

162
Q

Action of A1 receptors?

A

vasoconstriction
relaxation of GI smooth muscle
salivary secretion
hepatic glycogenolysis

163
Q

Alpha-2 receptor action

A

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

164
Q

Beta 1 receptor action?

A

mainly located in the heart
increase heart rate + force

165
Q

Beta 2 receptor action?

A

vasodilation
bronchodilation
relaxation of GI smooth muscle

166
Q

Beta 3 receptor action?

167
Q

Pathways for adreno receptors?

A

all are G-protein coupled

alpha-1:activate phospholipase C → IP3 → DAG
alpha-2: inhibit adenylate cyclase

beta-1: stimulate adenylate cyclase
beta-2: stimulate adenylate cyclase
beta-3: stimulate adenylate cyclase

168
Q

What vitamin can be malabsorbed in Metformin use?

169
Q

Indications for hyperbaric O2 use in CO poisoning?

A

Arrhytmia
EPSEs
LOC
Pregnancy

170
Q

Which Heparin is HIT increased risk with?

A

Unfractionated Heparin

171
Q

Blood test to monitor response to LMWH eg dalteparin?

A

Anti-factor Xa levels

172
Q

Dialysis in TCA overdose?

A

Ineffective

173
Q

Rash on forearms and face is suggestive of?

A

Photosensitivity rash

174
Q

methadone + buprenorphine MoA?

A

methadone is a full agonist of the mu-opioid receptor

buprenorphine is a partial agonist of the mu-opioid receptor and an antagonist of the kappa-opioid

175
Q

Risk of giving flumezanil with TCA overdose?

176
Q

Which drugs increase risk of digoxin toxicity?

A

amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin.

Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

177
Q

Normal anion gap?

178
Q

Ciclosporin - is it myelotoxic?

A

Virtually no

179
Q

Effect of cannabidiol on ciclosporin?

A

Increases conc of ciclosporin

180
Q

anticholinesterase (acetylcholinesterase inhibitor) refers to?

A

Organophosphates

181
Q

The dose of which TB drug needs to be adjusted in renal impairment and why?

A

Ethambutol - mainly renally excreted hence need to reduce dose

182
Q

Mx of salicylate dose?

A

ABC + activated charcoal (1st hour)

Urinary alkalination w sodium bicarb

Haemodialysis

183
Q

CI for sildefanil use?

A

patients taking nitrates and related drugs such as nicorandil + also doxasosin

hypotension

recent stroke or myocardial infarction (NICE recommend waiting 6 months)

184
Q

ITP and TTP which can you use IVIg for?

A

ITP

No place in TTP

185
Q

Drugs that can cause agranulocytosis?

A

Antithyroid drugs - carbimazole, propylthiouracil

Antipsychotics - atypical antipsychotics (CLOZAPINE)

Antiepileptics - carbamazepine

Antibiotics - penicillin, chloramphenicol, co-trimoxazole

Antidepressant - mirtazapine

Cytotoxic drugs - methotrexate

186
Q

Side effects with anti-hyperlipidaemia drugs:
Statins
Ezetimbe
Nicotinic acid (Niacin)
Fibrates
Cholestyramine

A

Statins - myositis + deranged LFTs

Ezetimbe - Headache

Nicotinic acid (Niacin) - myositis + flushing

Fibrates - Myositis, pruritis, cholestasis

Cholestyramine - GI side effects

187
Q

Drugs that can be cleared with haemodialysis?

A

mnemonic: BLAST

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

188
Q

Adverse effects of sildenafil?

A

visual disturbances
-blue discolouration
-non-arteritic anterior ischaemic neuropathy

nasal congestion

flushing

gastrointestinal side-effects

headache

priapism

189
Q

nivolumab moa?

A

PD-1 (programmed cell death) inhibitor.

190
Q

Bloods with adrenaline use?

A

hyperglycemia, hyperlactatemia and hypokalaemia

insulin secretion is suppressed

glycolysis and glycogenolysis, inducing an upsurge in lactate

increases lipolysis and decreases muscular proteolysis

191
Q

Gingival hyperplasia causes:

A

Gums Can Cause Pain and Ailments:

G → Gingival Hyperplasia
C → Calcium channel blockers (e.g., nifedipine)
C → Ciclosporin
P → Phenytoin
A → Acute myeloid leukaemia (which can also present with gingival hyperplasia due to leukemic infiltration)

192
Q

Drugs which cannot be cleared with haemodialysis include

A

benzodiazepines
beta-blockers
dextropropoxyphene (Co-proxamol)
digoxin
tricyclics

193
Q

Use of antiplatelets around dental practice?

A

Continue taking as normal

194
Q

The constant region of the antibody where dose this come from?

195
Q

phenylephrine moa?
clonidine moa?

A

A1 agonist -phenylephrine

A2 agonist -clonidine

196
Q

Dobutamine and salbutamol moa?

A

dobutamine = b1 agonist

salbutamol = b2 agonist

197
Q

Indications for haemodialysis in salicylate overdose?

A

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

198
Q

Which patients require HLA B*5801 allele testing?

A

high risk for allopurinol induced severe cutaneous adverse reaction:

Certain ethnic groups such as the Chinese, Korean and Thai people

diuretic use

CKD

199
Q

Drugs implicated in lithium toxicity?

A

diuretics (especially thiazides),

ACE inhibitors/angiotensin II receptor blockers,

NSAIDs

and metronidazole.

MRCP - Passmed (17 decks)

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