Drugs Flashcards
Target INR for venous thromboembolism, and target for recurrent thromboembolism
venous thromboembolism: 2.5
recurrent thromboembolism: 3.5
Target INR for atrial fibrillation
2.5
What is the INR?
Ratio of prothrombin time of the patient over the normal prothrombin time
Factors that may potentiate warfarin
Liver disease
P450 enzyme inhibitors: e.g. amiodarone, ciprofloxacin, cranberry juice
Drugs, which displace warfarin from plasma albumin e.g. NSAIDS
This drug can cause purple toes
Warfarin
Warfarin and pregnancy/breast feeding
Teratogenic so avoid in pregnancy, but can be used in breastfeeding
What drugs does clopidogrel interact with?
Interacts with PPIs
How does Fondaparinux work?
Activates antithrombin III
Statin monitoring?
LFTs at baseline, 3 months and 12 months
Hypocalcaemia is a side effect of which type of diuretic?
Loop diuretic
Which drugs are associated with angioedema?
ACE inhibitors
Which antibiotic should you avoid if you have long QT?
Erythromycin
Triad for Boerhaave syndrome?
Vomiting, thoracic pain, subcutaneous emphysema
commonly presents in middle aged men with a background of alcohol abuse
A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.
Proximal aortic dissection
A 52-year-old male presents with central chest pain and vomiting. He has drunk a bottle of vodka. On examination there is some mild crepitus in the epigastric region.
Boerhaave syndrome
Dipyridamole mechanism of action
Inhibits phosphodiesterase, elevating cAMP levels, which in turn reduce intracellular calcium levels
Ototoxicity is a side effect of which type of diuretic?
Loop diuretic
What type of drug is infliximab?
Monoclonal antibody - anti-tnf
What type of drug is adalimumab?
Monoclonal antibody - anti-tnf
What type of drug are ciclosporin and tacrolimus?
Calcineurin inhibitors
Side effects of tamsulosin
Dizziness, drowsiness, weakness Nausea and diarrhoea Headache, chest pain Abnormal ejaculation - decreased amount of sperm Back pain Blurred vision Fever, chills, aches, flu symptoms
How many units of alcohol can you drink?
Do not exceed more than 14 units per week, try to spread these over 3 days or more
Barrets oesophagus increases the risk of which type of cancer?
Adenocarcinoma
Achalasia increases the risk of which type of cancer?
Sqaumous cell
Lesions anywhere from mouth to anus
Crohn’s
Skip lesions
Crohn’s
Granulomas UC or Crohn’s?
Crohn’s
Transmural inflammation
Crohn’s
Pseudopolpys UC or Crohn’s
UC
A 43-year-old man with a history of Peutz-Jeghers syndrome presents with diarrhoea and rectal bleeding for the past ten days. On examination he has brown pigmented lesions on his lips and palms but abdominal and rectal examination is unremarkable. What is the most likely cause for this presentation?
Colon cancer
Is weight loss a feature of IBS?
NO!!!! Need to investigate
Which condition increases your risk of developing enteropathy associated T cell lymphoma
Coeliac disease
A 24-year old female presents to general practice with a few-weeks history of diarrhoea, passage of mucus, lethargy and abdominal discomfort relieved by defaection
IBS
First line anti-motility agent for diarrhoea in IBS?
Loperamide
Treatment for haemochromatosis
Vensection
A barium swallow which shows a grossly expanded oesophagus that tapers at the lower oesophageal sphincter (‘bird’s beak’ appearance)
Achalasia
Why are people with coeliac disease offered an annual pneumococcal vaccine?
They have hyposplenism
A 76-year-old woman presents with abdominal pain, distension and vomiting. She recently had an episode of acute cholecystitis and is awaiting a cholecystectomy. She feels her symptoms have returned over the past few days. On examination her abdomen is distended.
Gallstone ileus
A 62-year-old presents with upper abdominal pain. She has recently been discharged from hospital where she underwent an ERCP to investigate cholestatic liver function tests. The pain is severe. On examination she is apyrexial and has a pulse of 96 / min.
Acute pancreatitis
A 57-year-old woman with a history of gallstones presents with progressive right upper quadrant pain, rigors and jaundice.
Ascending cholangitis
A 48-year-old female presents to the GP with a lump in throat. She can swallow foods and liquids normally if she tries, although she has noticed the discomfort is worse on swallowing saliva. She does not have any pain on swallowing, chest pain or heart burn. Her appetite is normal.
Globus (the feeling of having a lump in the throat)
Primary sclerosing cholangitis is most associated with
Ulcerative colitis
If you are having endoscopy when should you stop taking omeprazole?
Stop taking 2 weeks before
Investigation of choice for liver cirrhosis
Transient elastography
Treatment for Wilson’s disease?
Penicillamine
Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages. When would you see this?
Laxative abuse
An 8-year-old boy presents with classical appendicitis pain, that has migrated from the umbilicus to the right iliac fossa within the last 12 hours. When the doctor palpates the left iliac fossa, the boy feels pain in the right iliac fossa. What is the name of this eponymous sign?
Rosving’s sign
McBurney’s point
The site where the pain from appendicitis is usually most severe on palpation. The point is on the right side of the abdomen, approximately one-third of the distance from the anterior superior iliac spine to the umbilicus
Kernig’s sign
Positive when the thigh is flexed at the hip and knee at 90-degree angles and subsequent extension of the knee elicits pain. This can be indicative of meningism of subarachnoid haemorrhage.
Psoas sign
Patient lies on their left side and the clinician extends the right hip with the knee fully extended. Abdominal pain on this movement indicates irritation of iliopsoas and possible appendicitis. This test usually indicates an appendix that lies in the retrocaecal position
Most common cause of hepatocellular cancer in a) europe b) worldwide
Europe - hep c
Worldwide - hep b
A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects which veins?
Connects the portal vein to the hepatic vein
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
Whipple’s disease
Anti-smooth muscle and anti-nuclear antibodies?
Autoimmune hepatitis
A 38-year-old woman presents with fever, malaise and jaundice. On examination she has moderate hepatomegaly. Laboratory analysis confirms a positive anti-smooth muscle antibody and anti-nuclear antibody. Antimitochondrial antibodies are negative.
Autoimmune hepatitis
What is peabodys sign
Peabody’s sign is clinically found in patients with a deep vein thrombosis (DVT) and a positive test indicated by calf muscle spasm occurring on elevation and foot extension of the affected leg
What is virchows node
Virchow’s node is an enlarged left supraclavicular lymph node seen in various internal abdominal malignancies
Why do you prescribe lactulose in hepatic encephalopathy?
Decreases production of ammonia in the intestines
Neomycin also licensed –> kills the bacteria that make ammonia
A 64-year-old man presents to his GP due to lethargy, anorexia and altered bowel habit. On examination he is noted to have non-tender hepatomegaly with a nodular edge. What is the likely diagnosis?
Metastatic cancer
What must you do before you take someone to surgery for appendicitis?
Give them broad spectrum antibiotics to reduce chances of post op complications
A 40-year-old man presents with symptoms of dysphagia that have been present for many months. His investigations demonstrate lack of relaxation of the lower oesophageal sphincter during swallowing.
Achalasia
Primary sclerosing cholangitis is associated with which antibodies?
ANCA and anti-smooth muscle cell antibodies
IgA and IgA TTG
Coeliac
Gold standard test for oesophageal cancer
Endocscopy
What is toxic megacolon?
Transverse colon >6cm
hamartomatous polyps in GI tract (mainly small bowel)
pigmented lesions on lips, oral mucosa, face, palms and soles
intestinal obstruction e.g. intussusception
gastrointestinal bleeding
Peutz Jeghers
Crypt abscesses
Ulcerative colitis
CRP and Crohn’s disease?
CRP correlates with disease activity
Kantor’s string sign?
Crohn’s
This TB medication can can cause a vitamin B6 deficiency causing peripheral neuropathy
Isoniazid
Following NICE guidance, what is the most appropriate way to screen for harmful alcohol drinking and alcohol dependence?
AUDIT questionnaire
When might you measure fecal calprotectin?
E.g. when you’re trying to distinguish between IBD and IBS (fecal calprotectin raised in inflammation)
μ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut
Loperamide
HNPCC increases risk of which type of cancers?
Colorectal and endometrial
Reduced serum caeruloplasmin
Wilsons
Which type of MEN is associated with Zollinger Ellison syndrome?
MEN I
What is Zollinger Ellison syndrome?
Zollinger-Ellison syndrome is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome
Which diabetes medication is most likely to cause cholestasis?
Gliclazide
Most common site affected in UC?
Rectum
The biggest risk factor for developing Barretts?
GORD
The three types of colon cancer
sporadic (95%)
hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
familial adenomatous polyposis (FAP, <1%)
What is the most appropriate test to confirm H. pylori eradication?
Urea breath test
Tinkling bowel sounds
Small bowel obstruction
What can you use octreotide for?
Used to treat the symptoms of carcinoid syndrome
Used in acromegaly
What is memantine
An NMDA antagonist
Used in Alzheimers
Reduces levels of glutamate
