Clinical pharmacology + toxicology Flashcards
(199 cards)
1
Q
Features of lithium toxicity?
A
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
2
Q
Mx of lithium toxicity?
A
mild-moderate - fluid resus
(monitor Na levels if concern of nephrogenic DI)
severe - haemodialysis may be required
3
Q
What are some side effects of metformin?
A
GI side effects
Lactic acidosis
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)
5
Q
What are some side effects associated with Glitazones?
A
Weight gain
Fluid retention + decompensation of HF
Liver dysfunction
Fractures
6
Q
What are some side effects associated with Gliptins?
A
Pancreatitis
7
Q
paraesthesia
visual field defects
hearing loss
irritability
renal tubular acidosis
Suggest what type of poisoning?
A
Mercury
8
Q
Which drugs can cause urinary retention?
A
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
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
10
Q
Octreotide MoA
A
Somatostatin analogue
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
12
Q
Which CCB can cause constipation?
A
Verapamil
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
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
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
16
Q
Digoxin MoA?
A
Na/K ATPase pump inhibitor
Class II antiarrhytmic also BBs
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
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)
19
Q
What are phase I and phase II reactions in drug metabolism?
A
phase I: oxidation, reduction, hydrolysis
phase II: conjugation
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
21
Q
Metformin MoA?
A
activation of the AMP-activated protein kinase (AMPK)
-> increased insulin sensitivity, decreased hepatic gluconeogenesis + ?reduced GI absorption of carbs
22
Q
abciximab MoA? use case?
A
glycoprotein IIb/IIIa receptor antagonist
used in prevention of ischaemic events in patients undergoing percutaneous coronary interventions
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
24
Q
Abdo pain / rectal bleeding following cocaine ingestion
Diagnosis?
A
Ischaemic colitis
25
Aspirin MoA?
Non-reversible COX 1 + 2 inhibitor
26
MoA of LMWH?
LMWH activates antithrombin III.
This forms a complex that inhibits factor Xa
27
MoA of Unfractionated heparin?
Unfractionated heparin forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa.
28
Rituximab MoA? Use?
MAb against CD20 used in R-CHOP regimen for non-hodgkins lymphoma
Also used in RA
29
Infliximab MoA? use?
Anti-TNFa used in RA and Crohns
30
Daratumumab MoA? Use?
Anti-CD38 used in multiple myeloma
31
Alemtuzumab MoA? Use?
Anti-CD52 used in CLL
32
Trastuzumab (Herceptin) MoA? Use?
Anti-HER2 used in HER2 +ve metastatic breast ca
33
Class 1a antiarrhytmics and some examples?
Mneumonic
“I am Ambivalent about the QUEEn PROofreading my DISsertation”: Class IA antiarrhythmic drugs are QUEEnidine, PROcainamide, DISopyramide.
These are Na channel blockers
34
Class 1b antiarrhytmics and some examples?
“LInDO MEXIco Is the Best”: LIDOcaine and MEXIletine are class IB antiarrhythmic drugs.
Also Na channel blockers
35
Class 1c antiarrhytmics and some examples?
Mneumonic
“I Can't Fail, Please”: Class IC antiarrhythmics are Flecainide, Propafenone.
36
Class 3 antiarrhytmics and some examples?
Mneumonic
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.
37
Features of organophosphate poisoning? Mneumonic
SLUDD
s=salivation
l=lacrimation, low BP, low pluse
u= urination
d=defecation
d=diarrhea, decrease pupil size.
38
Prognostic factors in Paracetamol Overdose
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)
39
MoA of allopurinol?
Allopurinol inhibits xanthine oxidase
(which oxidises 6-mercaptopurine into 6-thiouric acid)
40
TCA overdose with hypotension / widened QRS / VT
Mx?
IV bicarb
41
Which drugs commonly interact with CYP450 inhibitors / inducers?
Warfarin the Combined Contraceptive Pill, Theophylline, Corticosteroids, Tricyclics, Pethidine, and Statins.
42
Which drugs are common CYP450 inducers?
CRAP GPS - generally need prolonged exposure
Carbemazepines (+Phenytoin)
Rifampicin
Alcohol - chronic
Phenytoin
Griseofulvin
Phenobarbitone (Barbiturates)
Sulphonylureas + Smoking + St Johns Wort
Reduced drug concentration
43
Which drugs are common CYP450 inhibitors? effect?
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
44
Drugs which are known to cause impaired glucose tolerance include:
'STATIN':
Steroids
Thiazides - Furosemide also but less
Antipsychotics
Tacrolimus/ciclosporin
Interferon-alpha
Nicotinic acid
45
Pilocarpine MoA?
Muscarinic agonist - M1-3 -> induction of parasympathetic action
46
Which drugs can cause cataracts?
steroids
47
Which drugs can cause corneal opacities?
amiodarone
indomethacin
48
Which drugs can cause optic neuritis?
ethambutol
amiodarone
metronidazole
49
Which drugs can cause retinopathy?
chloroquine, quinine
50
What can happen to the eyes with sildenafil?
Blue discolouration
Non-arteritic anterior ischaemic neuropathy
51
Why can Sodium Bicab be considered in lithium toxicity?
Increases urine alkalinity thus promoting lithium excretion
52
HTN in Lithium patients?
ACE-i and ARBs can cause toxicity
CCBs - Diltiazem / Verapamil - increase risk of neurotoxicity
Amlodipine is fine
53
54
When to give sodium bicarb in mx of TCA overdose?
pH <7.1
widened QRS esp >160 ms
Arrhythmias
Hypotension
55
Example of a1 antagonist?
doxasosin
56
Example of a1a agonist?
tamsulosin acts mainly on urogenital tract
57
Example of a2 antagonist?
yohimbine
58
example of non-selective a antagonist
phenoxybenzamine - used be used in peripheral arterial disease
59
Example of b1 antagonist?
Atenolol
60
Example of non-selective b antagonist?
Propanolol
61
example of a + b mixed antagonists?
Carvedilol
Labetalol
62
confusion, headache, and characteristically cherry-pink mucous membranes
Suggestive of what condition?
CO poisoning
63
How does aspirin achieve antiplatelet effect?
Inhibits the production of thromboxane A2 secondary to irreversible inhibition of COX1
64
How do ciclosporin and tacrolimus work?
Inhibit calcineurin in T cells thus decreasing IL-2
65
Mx of organophosphate poisoning?
Atropine
66
Which drugs commonly cause urticaria?
aspirin
penicillins
NSAIDs
opiates
67
Which medications are best for motion sickness?
Motion sickness - hyoscine > cyclizine > promethazine
68
Ketamine MoA?
NMDA receptor antagonist
69
MoA of finasteride and adverse effects?
Finasteride = 5a reductase inhibitor
Adverse:
>impotence
>decrease libido
>ejaculation disorders
>gynaecomastia and breast tenderness
70
Disadvantages of POP contraceptive?
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
71
Licensed indications for Botox?
blepharospasm
hemifacial spasm
focal spasticity including cerebral palsy patients, hand and wrist disability associated with stroke
spasmodic torticollis
severe hyperhidrosis of the axillae
achalasia
72
Management of accidental injection of adrenaline? e.g. resulting in digital ischaemia
Local infiltration of phentolamine
73
Drugs that most commonly cause urticaria?
aspirin
penicillins
NSAIDs
opiates
74
Blood gas in mercury poisoning + why?
Hyperchloraemic metabolic acidosis consistent with renal tubular acidosis i
75
Which abx inhibit protein synthesis by acting on 30s subunit of ribosome?
Aminoglycosides - Gentamicin
Tetracyclines - demeclocycline
76
Which abx inhibits DNA synthesis?
quinolones (e.g. ciprofloxacin)
77
MoA of Metronidazole?
Damage DNA
78
Which abx inhibit folic acid formation
Sulphonamides
trimethoprim
79
Which endocrine med can cause gallstones secondary to biliary stasis?
Octreotide - somatostatin analogue
80
Mx of BB overdose?
if bradycardic then atropine
in resistant cases glucagon may be used
81
Mx of lead poisoning?
Dimercaprol, calcium edetate
82
Mx of Cyanide poisoning?
Hydroxocobalamin;
also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
83
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?
Quinine toxicity - cinchonism
Prolonged QT, QRS which can degenerate into ventricular tachyarrhythmias / fibrillation
84
What is the benefit of humanising antibodies?
Decreases immunogenicity of mab
85
Which abx work by inhibiting protein synthesis by acting on 50s subunit of ribosome?
50S subunit: macrolides, chloramphenicol, clindamycin, linezolid, streptogrammins
86
Which medications exhibit saturation kinetics (Zero-order)
zero order kinetics-> SHEEP
Salicylates-S
Heparin-HE
Ethanol-E
Phenytoin-P
87
MoA of Cetuximab?
Cetuximab - monoclonal antibody against the epidermal growth factor receptor
Used in met colorectal ca + Head and neck ca
88
MoA of heparin induced thrombocytopaenia?
antibodies form against complexes of platelet factor 4 (PF4) and heparin
Develops 5-10d of treatment in
This is a pro-thrombotic condition
89
What is the MoA of erythromycin for gastroparesis?
Acts as motilin receptor agonist -> promoting gastric emptying
90
What should happen to Metformin during MI and why?
Stopped due to risk of lactic acidosis
91
MoA of tacrolimus?
Decreases IL2 release via inhibition of calcineurin
92
MoA of fomipezole? When is it used?
Competitive inhibitor of alcohol dehydrogenase
Used in preference to alcohol in ethylene glycol poisoning
93
MoA of polyuria in excess alcohol
Ethanol reduces the calcium-dependent secretion of anti-diuretic hormone (ADH) by blocking channels in the neurohypophyseal nerve terminal.
94
When is Flecainide CI?
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
Uses of octreotide?
acute treatment of variceal haemorrhage
acromegaly
carcinoid syndrome
prevent complications following pancreatic surgery
VIPomas
refractory diarrhoea
96
What is MCAT similar to?
Amphetamine
97
Abx likely to cause photosensitive rash?
Tetracycline
98
What blood test changes can be seen delayed in response to excess paracetamol?
Delayed paracetamol nephrotoxicity
99
Which type of abx can cause tendon rupture?
Quinolones
100
Mx of Cocaine induced CP / MI?
benzodiazepines + glyceryl trinitrate
If MI also PCI
101
Mx of Cocaine induced HTN?
benzodiazepines + sodium nitroprusside
102
Mx of oculogyric crisis?
cessation of causative medication if possible
intravenous antimuscarinic: benztropine or procyclidine
103
When is it classified as severe lithium toxicity? mx?
>2.5 mmol/L
Haemodialysis
104
What are the side effects of ciclosporin?
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
What medication causes blue vision?
blue vision: Viagra ('the blue pill')
106
What effect can sulphonylureas cause on kidneys?
SiADH
107
Phenylephrine MoA?
a1 agonist
108
Tamsulosin MoA?
A-1a antagonist
109
LMWH MoA?
Low-molecular weight heparin activates antithrombin III.
Forms a complex that inhibits factor Xa
110
Pilocarpine MoA?
Muscarinic receptor agonist
111
Sildenafil MoA?
phosphodiesterase type V inhibitor
112
Drugs to avoid in pregnancy?
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
How long to wait between increasing Metformin doses?
1 week at least
114
Levothyroxine acts on what receptor?
Nuclear receptors
115
Which CCB can cause constipation?
Verapamil
116
How to screen for high risk of allopurinol induced severe cutaneous adverse reactions (SCARs)
Screen for HLA-B *5801 allele
NB SCARs include SJS and TEN
117
How to distinguish between TEN and SJS?
It is based on body surface affected
< 10% for SJS
> 30% for TEN
118
Mx of CO poisoning?
1st 100% high flow o2
2nd Hyperbaric O2 if refractory esp if >25% carboxyHb
119
Local anesthetic toxicity mx?
IV 20% lipid emulsion
120
Side effects of BBs?
* Bronchospasm (especially in asthmatics)
* Fatigue
* Cold peripheries
* Sleep disturbances
121
Side effects of nitrates?
* Headache
* Postural hypotension
* Tachycardia
122
Side effects of Nicorandil
* Headache
* Flushing
* Anal ulceration
123
Which drugs can cause nightmares?
MNEMONIC - Nightmares: BAM! ... VLAM!:
Beta Blockers;
Amiodarone;
Monteleukast;
Verapamil;
Levodopa;
Amitriptyline;
Morphine.
124
class IV antiarrhytmics MoA + examples?
calcium channel blockers
eg Diltiazem + Verapamil
125
How to distinguish between methanol and ethylene glycol poisoning?
Methanol = eye signs eg macular oedema, poor pupilary responses, maybe not following gaze / asking for lights to be switched on
126
Name a depolarising NMJ blocker? any interesting facts?
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
Name a non-depolarising NMJ blocker? onset? reversal agent
AVP
Atracurium, Vecuronium, Pancuronium
1st two = 30-45 mins
3rd = 2-3 mins
Reversal = Neostigmine (only partial action on Pancuronium)
128
Why should hypotonic saline (0.45%) be avoided in paediatrics?
Risk of hyponatraemic encephalopathy
129
Blood gas findings and BMs in Quinine toxicity?
Metabolic acidosis
Hypoglycaemia
130
What drugs can cause hypomagnesaemia?
Diuretics
PPIs
131
What electrolyte disturbances and metabolic disorders can cause hypomagnesaemia?
Hypokalaemia
Hypercalcaemia
Gitlemans and Bartters syndromes
132
Effect of cocaine on pregnant women? what else has the same effects?
Intrauterine growth retardation
Preterm labour
Smoking also has these same effects
133
Lithium effect on pregnancy?
Ebsteins anomaly
134
Effect of certain abx with pregnancy?
color change --- grey teeth and grey baby syndrome
135
Effect of epilepsy drugs on pregnancy?
brain -- craniofacial abnormalities and neural tube defects
136
Causes of normal anion gap metabolic acidosis?
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
Causes of raised anion gap metabolic acidosis?
Causes of high anion gap metabolic acidosis (HAGMA) include:
Lactate
Toxins (e.g. methanol, paracetamol, propylene glycol)
Ketones
Renal failure
138
The presence of hypokalemia with NAGMA is suggestive of what?
Type 1 RTA can be caused by mercury poisoning
139
Mx of serotonin syndrome?
supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
140
Features of serotonin syndrome?
Faster onset v neuroleptic malignant syndrome (hours v hours-days)
Hyperreflexia, clonus and dilated pupils (NM excitation)
Hyperthermia + sweating (autonomic excitation)
Confusion
141
Teicoplanin MoA?
Similar to Vanc - glycopeptide abx but longer duration hence OD dosing
inhibit peptidoglycan synthesis
142
Burning plastics, bitter almond smeel and red ashen appearance is suggestive of what type of poisoning? How does this work?
Cyanide poisoning - inhibits the enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain
143
Features of chronic cyanide poisoning?
chronic: ataxia, peripheral neuropathy, dermatitis
144
Amiloride/ Triamterene MoA? when is it used?
blocks the epithelial sodium channel in the distal convoluted tubule
Acts as K sparing diuretic
Used in Liddle's syndrome (ENaC disorder)
145
What are drug induced causes of thrombocytopaenia?
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
What drugs are affected by acetylator status?
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
Which drugs can percipitate an attack of acute intermitten porphyria
Blood Problems Have A Sneaky Behaviour
* Barbiturates
* Pill- OCP
* Halothane
* Alcohol
* Sulphonamides
* Benzodiazepines
148
What is the Wolff-Chaikoff effect? What drug can cause this?
Autoregulatory phenomenon where thyroxine formation is inhibited due to high levels of circulating iodide
Amiodarone - can still be continued if this happens
149
What is AIT and describe its features and mx?
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
What is in antifreeze?
Ethylene glycol
151
Cardiac features of ethylene glycol toxicity?
HTN and tachycardia
152
Products of phase I reactions are typically more lipid soluble - true or false?
False - they are more water soluble
153
What are the indications for dopamine agonists? what are the adverse effects?
Parkinson's disease
prolactinoma/galactorrhoea
cyclical breast disease
acromegaly
Adverse effects:
nausea/vomiting
postural hypotension
hallucinations
daytime somnolence
154
What causes QT shortening?
Hypercalcaemia,
hypermagnesaemia,
digoxin, or
thyrotoxicosis
155
What causes QT prolongation?
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
What drugs can cause photosensitivity?
SCANTy clothing causes sunburn
Sulphonamides
Ciprofloxacin
Amiodarone
NSAIDS
TetracYclines/thiazides
157
Adverse effects associated with trastuzumab (Herceptin)?
flu-like symptoms and diarrhoea are common
Cardiotoxicity - echo prior to tx (more common when anthracyclines (-rubicin) have also been used)
158
What are the features of DRESS syndrome?
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
Features of TCA overdose?
Anticholinergic effects
Visual disturbances
Urinary retention
Dry mouth
Constipation
Can't see, can't pee, can't spit, can't shit
+ QT prolongation
160
When to check levels for:
Ciclosporin
Digoxin
Phenytoin
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
alcohol dehydrogenase and xanthine oxidase which phase of drug metabolism?
Phase 1
162
Action of A1 receptors?
vasoconstriction
relaxation of GI smooth muscle
salivary secretion
hepatic glycogenolysis
163
Alpha-2 receptor action
mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves)
inhibits insulin
platelet aggregation
164
Beta 1 receptor action?
mainly located in the heart
increase heart rate + force
165
Beta 2 receptor action?
vasodilation
bronchodilation
relaxation of GI smooth muscle
166
Beta 3 receptor action?
lipolysis
167
Pathways for adreno receptors?
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
What vitamin can be malabsorbed in Metformin use?
b12
169
Indications for hyperbaric O2 use in CO poisoning?
Arrhytmia
EPSEs
LOC
Pregnancy
170
Which Heparin is HIT increased risk with?
Unfractionated Heparin
171
Blood test to monitor response to LMWH eg dalteparin?
Anti-factor Xa levels
172
Dialysis in TCA overdose?
Ineffective
173
Rash on forearms and face is suggestive of?
Photosensitivity rash
174
methadone + buprenorphine MoA?
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
Risk of giving flumezanil with TCA overdose?
Seizure
176
Which drugs increase risk of digoxin toxicity?
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
Normal anion gap?
12-16
178
Ciclosporin - is it myelotoxic?
Virtually no
179
Effect of cannabidiol on ciclosporin?
Increases conc of ciclosporin
180
anticholinesterase (acetylcholinesterase inhibitor) refers to?
Organophosphates
181
The dose of which TB drug needs to be adjusted in renal impairment and why?
Ethambutol - mainly renally excreted hence need to reduce dose
182
Mx of salicylate dose?
ABC + activated charcoal (1st hour)
Urinary alkalination w sodium bicarb
Haemodialysis
183
CI for sildefanil use?
patients taking nitrates and related drugs such as nicorandil + also doxasosin
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
184
ITP and TTP which can you use IVIg for?
ITP
No place in TTP
185
Drugs that can cause agranulocytosis?
Antithyroid drugs - carbimazole, propylthiouracil
Antipsychotics - atypical antipsychotics (CLOZAPINE)
Antiepileptics - carbamazepine
Antibiotics - penicillin, chloramphenicol, co-trimoxazole
Antidepressant - mirtazapine
Cytotoxic drugs - methotrexate
186
Side effects with anti-hyperlipidaemia drugs:
Statins
Ezetimbe
Nicotinic acid (Niacin)
Fibrates
Cholestyramine
Statins - myositis + deranged LFTs
Ezetimbe - Headache
Nicotinic acid (Niacin) - myositis + flushing
Fibrates - Myositis, pruritis, cholestasis
Cholestyramine - GI side effects
187
Drugs that can be cleared with haemodialysis?
mnemonic: BLAST
Barbiturate
Lithium
Alcohol (inc methanol, ethylene glycol)
Salicylates
Theophyllines (charcoal haemoperfusion is preferable)
188
Adverse effects of sildenafil?
visual disturbances
-blue discolouration
-non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism
189
nivolumab moa?
PD-1 (programmed cell death) inhibitor.
190
Bloods with adrenaline use?
hyperglycemia, hyperlactatemia and hypokalaemia
insulin secretion is suppressed
glycolysis and glycogenolysis, inducing an upsurge in lactate
increases lipolysis and decreases muscular proteolysis
191
Gingival hyperplasia causes:
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
Drugs which cannot be cleared with haemodialysis include
benzodiazepines
beta-blockers
dextropropoxyphene (Co-proxamol)
digoxin
tricyclics
193
Use of antiplatelets around dental practice?
Continue taking as normal
194
The constant region of the antibody where dose this come from?
Humans
195
phenylephrine moa?
clonidine moa?
A1 agonist -phenylephrine
A2 agonist -clonidine
196
Dobutamine and salbutamol moa?
dobutamine = b1 agonist
salbutamol = b2 agonist
197
Indications for haemodialysis in salicylate overdose?
serum concentration > 700mg/L
metabolic acidosis resistant to treatment
acute renal failure
pulmonary oedema
seizures
coma
198
Which patients require HLA B*5801 allele testing?
high risk for allopurinol induced severe cutaneous adverse reaction:
Certain ethnic groups such as the Chinese, Korean and Thai people
diuretic use
CKD
199
Drugs implicated in lithium toxicity?
diuretics (especially thiazides),
ACE inhibitors/angiotensin II receptor blockers,
NSAIDs
and metronidazole.
