Drugs

Question 1

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

patients on this drug need to have regular monitoring of what

Answer 1

patients on this drug need to have regular monitoring of their full blood count

neutrophils

Question 2

what is agranulocytosis

Answer 2

Agranulocytosis is a life-threatening blood disorder. It happens when the body doesn’t make enough of a type of white blood cells called neutrophils

Question 3

prednisolone

what is the most common adverse affect

Answer 3

hyperglycaemia

Most patients on steroids have an increase in their appetite and in weight gain, thus anorexia or weight loss are not appropriate answers.

In addition steroid hormones can have some function at the aldosterone receptor in the collecting duct, thus stimulation of this could have the effect of causing hyponatremia.

While changes in vision is a possible side effect, due to steroid induced cataracts, this is significantly less common.

High levels of non-endogenous steroids have risk factors including;
Hyperglycemia
High blood pressure
Obesity (above the waste and not limbs)
Wasting of skeletal muscles
Poor wound healing
Mood swings and depression

the BNF suggests gradual withdrawal of systemic corticosteroids if patients have: received more than 40mg prednisolone daily for more than one week, received more than 3 weeks treatment or recently received repeated courses

Question 4

A key concept for the exam is to understand that salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis. In children metabolic acidosis tends to predominate.

treatment

Answer 4

Treatment
general (ABC, charcoal)
urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
haemodialysis