Drugs remember

Question 1

The following drugs tend to cause a hepatocellular picture:

Answer 1

paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin

Question 2

The following drugs tend to cause cholestasis (+/- hepatitis):

Answer 2

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

(ACAB, prochlor suphur caused raised ALP)

Question 3

Less sedative TCA?

Answer 3

Imipramine
Lofepramine
Nortriptyline

Question 4

more sedative TCA?

Answer 4

Amitriptyline
Clomipramine
Dosulepin
Trazodone*

Question 5

1st rank SX? 4 cats?

Answer 5

auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions

Question 6

Causes of long QT interval?

Answer 6

. Genetic:
LQT1 / LQT2 (potassium channel mutation); LQT3 (sodium channel mutation)
Jervell and Lange-Nielsen syndrome (associated with deafness)
Romano-Ward syndrome
2. Electrolytes:
Hypocalcaemia
Hypomagnesaemia
Hypokalaemia
3. Drugs:
Antiarrhythmics (e.g. amiodarone, sotalol)
Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)
Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)

Question 7

features of anticholinergic OD?

Answer 7

agitation, tachycardia, mydriasis, and hyperthermia

eg due to excess antihistamine, chlorphenamine

Question 8

Which OD gives resp alkalosis?

Answer 8

aspirin overdose, respiratory alkalosis occurs early due to stimulation of the brainstem medullary respiration centre. This is later followed by metabolic acidosis, due to uncoupling of oxidative phosphorylation. This early respiratory alkalosis may present with shortness of breath alone

Question 9

drug induced thrombocytoenia CX?

Answer 9

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

Question 10

SIADH drug CX?

Answer 10

sulfonylureas*
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide

Question 11

Before the induction of anaesthesia, the following must have been checked

Answer 11

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

Question 12

RTA - type 1 . explain?

Answer 12

inability to generate acid urine (secrete H+) in distal tubule
causes hypokalaemia
complications include nephrocalcinosis and renal stones
causes include idiopathic, rheumatoid arthritis, SLE, Sjogren’s, amphotericin B toxicity, analgesic nephropathy

Question 13

RTA type 2 ? expalin? main cause?

Answer 13

decreased HCO3- reabsorption in proximal tubule
causes hypokalaemia
complications include osteomalacia
causes include idiopathic, as part of Fanconi syndrome, Wilson’s disease, cystinosis, outdated tetracyclines, carbonic anhydrase inhibitors (acetazolamide, topiramate)

Question 14

RTA Type 4 - explain?

Answer 14

reduction in aldosterone leads in turn to a reduction in proximal tubular ammonium excretion
causes hyperkalaemia
causes include hypoaldosteronism, diabetes

Question 15

Causes of raised prolactin

Answer 15

prolactinoma
pregnancy
oestrogens
physiological: stress, exercise, sleep
acromegaly: 1/3 of patients
polycystic ovarian syndrome
primary hypothyroidism (due to thyrotrophin releasing hormone (TRH) stimulating prolactin release)

Drug causes of raised prolactin
metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids

Question 16

Drug CX of peripheral neuropathy?

Answer 16

amiodarone
metronidazole
nitrofurantoin
isoniazid
phenytoin

Question 17

VTE risk drugs?

Answer 17

oestrogen + progestogen preparations compared to those taking oestrogen-only preparations
raloxifene and tamoxifen
antipsychotics (especially olanzapine) have recently been shown to be a risk factor

Question 18

CX of neutrophilia?

Answer 18

viral
HIV
Epstein-Barr virus
hepatitis
drugs
cytotoxics
carbimazole
clozapine
benign ethnic neutropaenia
common in people of black African and Afro-Caribbean ethnicity
requires no treatment
haematological malignancy
myelodysplastic malignancies
aplastic anemia
rheumatological conditions
systemic lupus erythematosus: mechanisms include circulating antineutrophil antibodies
rheumatoid arthritis: e.g. hypersplenism as in Felty's syndrome
severe sepsis
haemodialysis