extra

Question 1

how does phenytoin interact with sulfonylureas, sodium valproate, salicylates

Answer 1

displaces from albumin protein binding sites

also in renal failure, acidic drug less avidly binds to protein albumin sites

Question 2

Abx success depends on…
penicillin, clindamycin, cephalosporins, carbapenems
aminoglycosides and quinolones
vanc

Answer 2

• spend more than 40-50% time above MIC
• peak concentration
• time AUC/MIC ratio

Question 3

proportion of drug reabsorbed in the renal tubule depends on

Answer 3

pH of urine

for any drugs that are lipid soluble enough to be reabsorbed and can ionise to an anion or cation, renal clearance varies with urine pH - only non ionised can pass through lipid membrane easily

Question 4

Ivabradine works by

Answer 4

reducing heart rate Without EFFECTS ON LV FUNCITON

Acts in If channel in the SA node

Question 5

How is indapamide different from thiazides?

Answer 5

lipid soluble
highly bound to blood proteins
little eliminated in the urine

Like thiazides inhibits DCT sodium reabs

also antihypertensive by reducing peripheral vascular resistance by inhibiting calcium influx into smooth muscles

Question 6

Paracetamol toxicity will be increased where what happens to CYP450

Answer 6

induces!!!

Question 7

Which receptor is involved in opioid related dysphoria, hallucinations, psychosis?

Answer 7

Sigma receptors!

mu do analgesia, euphoria, miosis, sedation, resp depression

kappa do analgesia, mitosis, resp depression, sedation

delta unknown

Question 8

sirolimus scary side effect

Answer 8

pneumonitis

Question 9

Which immunosupressant can also be used to treat BK nephropathy?

Answer 9

leflunomide

both antiviral and immunosupressive
Used in RA and renal transplant
good for BK and CMV

Question 10

major clozapine interactions to watch out for

Answer 10

CYP 1A2

smoking cessation decrease metab
agranulocytosis worst risk first three months
cipro, fluvoxamine are inhibitors

Question 11

Tyramine eg red wine with MAOB- what happens

Answer 11

stimulates norad release
of stores
hypertensive crisis

note not a problem with the MAOB selective like silegiline

Question 12

atypical antipsychotics block

Answer 12

D2
and 5-HT2

MAY also block D1

Question 13

TCA work how

Answer 13

block reuptake of NA, serotonin

AND
block alpha 1 adrenergic, serotonergic, histaminergic and cholinergic receptors

Question 14

early lithium level in overdose….

Answer 14

dont trust! Takes ages to distribute
initial high level can fall over hours

consider dialysis if coma or convulsions aboev 2.5 or otherwise at 4

+ HYDRATE to promote excretion

Question 15

autonomic picture in NMS

Answer 15

labile picture

CAN be normal CK