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Pharmacy Prep > Literally Everything > Flashcards

Literally Everything Flashcards

1
Q

Name the Category 1 Anti-epileptics

A

Primidone

Phenytoin

Phenobarbital

Carbamazepine

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2
Q

What are the common causes of a chronic cough?

A 
Asthma
Pneumonia
Bronchitis 
COPD
TB
Lung Cancer
ACEi
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3
Q

Customer comes in to the pharmacy and request Day Nurse to help with his cold. He’s never had it before but heard it was good from a friend.

Current Medication:
- Bisoprolol 5mg OD

A

Do not give!

Day Nurse contains pseudoephedrine.
Bisoprolol is a beta blocker.

Increased risk of hypertension.

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4
Q

Recommended for the treatment atrial flutter with structural heart defects or after heart surgery

A

Amiodarone

or

Sotalol

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5
Q

Which Beta Blockers tend to cause less Bradycardia?

A

Caliprolol
Acebutolol
Pindolol
Oxprenolol

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6
Q

What is Simeticone and what is it used for?

A

An anti-foaming agent used to prevent flatulence

  • hiccup relief in palliative care
  • licenced for infantile colic/wind pain
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7
Q

What is sotalol?

A

a non-Cardioselective BB, with Class III antiarrhythmic activity.

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8
Q

Which is more effective in the treatment of sustained ventricular tachycardia:

lidocaine or sotalol

A

Sotalol

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9
Q

How do Beta Blockers work as anti-arrythmics?

A

By attenuating the effects of the sympathetic system on automaticity and conductivity within the heart

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10
Q

What is Exocrine Pancreatic Insufficiency?

A

reduced secretion of pancreatoc enzymes into the duodenum.

Manifests as:
- maldigestion and malnutrition
(low circulating micronutrients, fat-soluble vitamins and lipoprotiens)
- Diarrhoea, abdominal cramps etc

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11
Q

Why do we not abruptly stop antiepilects?

A

Abrupt withdrawal can cause severe rebound seizures

particularly with barbiturates
barbiturate withdrawal may take several months

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12
Q

Enzyme Inducers

A 
Carbemazepine
Rifampicin
Alcohol
Phenytoin 
Griseofulvin
Phenobarbital
St Johns Wort`
(Barbiturates, Smoking, Primidone, Topiramate, Ritonavir, Rifabutin)
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13
Q

CSM Warning for Pancreatin

A

The use of high strength preparations has been associated with the development of large bowel strictures (fibrosing colonopathy) in children with cystic fibrosis aged between 2 - 13 yrs

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14
Q

What is Digoxin?

A

A cardiac glycoside

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15
Q

Digoxin Indications

A

Atrial Fibrillation
Tachycardia
Heart Failure

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16
Q

How does Digoxin work?

A

as a positive inotrope

–> Increases the force of myocardial contraction and reduces conductivity within the AV node

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17
Q

Side Effects of:

Digoxin

A 
Nausea 
Vomiting 
Diarrhoea
Dizziness
Blurred Vision
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18
Q

Desired Serum Concentration of:

Lithium

A

0.4 - 1 mmol/L

> 1.5 mmol/L may be toxic and fatal

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19
Q

Recommended for the treatment atrial flutter without structural heart defects or after heart surgery

A

D.C. shock or Cardiac pacing.

Drug treatment not necessary

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20
Q

Main counselling point to a 28 year old woman prescribed Basiliximab

A

woman of child bearing potential should use adequate contraception to prevent pregnancy, and continue to use it for an additional 4 months after the last dose of Basiliximub.

They should also not breast feed for 4 months after the last dose.

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21
Q

Lithium counselling points

A

Maintain adequate fluid intake

Avoid dietary changes which reduce or increase sodium intake.

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22
Q

Which Beta Blockers are water soluble?

A

celiprolol
Atenolol
Nadolol
Sotalol

less likely to enter the blood brain barrier, therefore less likely to cause sleep disturbances and nightmares

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23
Q

How are water soluble Beta blockers excreted?

A

Via the kidneys

dose reduction is often needed in renal impairment

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24
Q

Names some bisphosphonates

A

Alendranate | Risadronate

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25
Q

Bisphosphonates indication

A

Secondary prevention of osteoparatic fractures in susceptible post-menopausal women.

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26
Q

Raloxifene indication

A

For those who can not take bisphosphonates or who have suffered a fragility fracture despite treatment for a year and have a decline in bone marrow density (below pre-treatment level)

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27
Q

What is Teriparatide?

A

Parathyroid hormone fragment, used in osteoporosis.
for woman >65, who can’t take bisphosphonates (or for who bisphosphonates have failed) and have:
- extremely low bone marrow density
or
- low bone marrow density, suffered more than 2 fractures, BMI < 19 and premature menopause

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28
Q

Prevalence of G6PD deficiency?

A

Africans
Asians
South Europeans

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29
Q

Define MCV

and state normal range

A

The average volume of a red blood cell.

Normal: 80 - 100fl

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30
Q

Possible causes of a high MCV

A

Methotrexate toxicity

Folic acid deficiency

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31
Q

Normal white blood cell count

A

4 - 11 x10^9 /f

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32
Q

Causes of abnormal white blood cell count

A

High WBC could indicate::

  • infection
  • person is on steriods

Low WBC could indicate:
- Methotrexate harming bone marrow

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33
Q

Normal Platelet Count

A

150 - 400 x10^9/L

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34
Q

Possible cause of abnormal platelet count

A

Low platelet count could indicate:

- Methotrexate harming bone marrow

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35
Q

Normal Lymphocyte Count

A

1.5 - 4.0 x10^9/L

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36
Q

What is:

Bendroflumethiazide

its indication and side effects

A

Moderately potent Thiazide Diuretic

Indicated in Mild-Moderate Heart failure and Hypertension

Side Effects:
GI disturbance | postural HTN | Hypokalemia | Hyponatremia | Gout | Hypercalcemia

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37
Q

Time of on set and duration of action of

Bendroflumethiazide

A

Acts within 1-2hrs

Lasts 12 - 24 hrs

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38
Q

Define:

Hypercalcaemia

A

Excess calcium

> 3.5 mmol/L

Can cause renal damage and cardiac arrest

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39
Q

Causes Hypercalcaemia

A 
Malignancy with bone marrow
Thyrotoxicosis
Hyperparathyroidism
Thiazides 
Lithium
Tamoxifen
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40
Q

What may a raised ALT/AST indicate

A

Liver inflammation

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41
Q

Define high Serum Urea, and what it could indicate

A

> 10 mmol/L

Could indicate renal failure, dehydration, high dietary protein intake, hypercatabolic state or haemorrhage.

Note: further tests are required to give more accurate assessments

If renally impaired, all drugs with significant renal excretion needs to be assessed

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42
Q

Normal Urea range

A

2.5 - 8 mmol/L

varies with age

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43
Q

Normal Creatinine range

A

60 - 125 micromol/L

varies with age

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44
Q

What are the parameters of Renal function in terms of creatinine clearance?

A

Normal > 90 ml/min/1.73m^2
Mild 60 - 90 ml/min/1.73m^2
Moderate 30 - 59 ml/min/1.73m^2
Severe 15 - 29 ml/min/1.73m^2

Established Renal Failure < 15 ml/min/1.73m^2

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45
Q

Why should we eradicate Helicobacter Pylori?

A

To reduce recurrence of gastric and duodenal ulcers and the risk of re-bleeding

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46
Q

For zolmitriptan orodispesible 2.5 mg tablets why is:

“Repeat the dose after 2 hours, if you experience no relief from the first dose” Inappropriate advise?

A

Because if a patient does not respond to the first dose it is unlikely that a second dose will benefit the same attack

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47
Q

HLA-B ISO2 allele is tested in which patients before starting on which medication, for what reason?

A

Tested in Han Chinese of Thai patients

Before starting on Carbamazipine or Eslicarbazepine

Due to risk of Steven Johnson Syndrome if test is positive.

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48
Q

What is Steven Johnson Syndrome?

A

is a rare, serious disorder of your skin and mucous membranes. It’s usually a reaction to a medication or an infection. Often, it begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters

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49
Q

Carbemazipine monitoring requirements?

A

Optimum response with a plasma concentration:
4 - 12 mg/L
(20 - 50 micromol/L)
measured after 1 - 2 weeks

Blood Counts
LFTs
Renal Tests

50
Q

Treatment of Febrile Convulsions

A

Brief Convulsions - No specific treatment
Paracetamol to reduce fever and prevent further convulsions

Prolonged Convulsions ( > 5 minutes)
as for convulsive status epilepticus
IV Lorazepam

51
Q

Treatment of non-convulsive status epilepticus

A

Urgency depends on severity of the patients condition
If:

  • incomplete loss of awareness:
    Usual oral antiepileptic therapy should be continued or restarted
  • Failure to respond or complete lack of awareness:
    IV Lorazepam
52
Q 
Patient has convulsive status epilepticus.
What would you give first: IV:  
Diazepam 
or
Lorazepam
A

Lorazepam

diazepam is effective but comes at a high risk of thrombophlebitis

53
Q

What regulations apply to Selegeline?

A

Driving regulations apply as it is converted to amfetamine

54
Q

Treatment of Status Epilepticus

A
  1. Position patient to avoid injury
  2. Give O2
  3. Maintain BP
  4. Correct any hypoglycemia
    (Give thiamine if alcohol abuse is suspected)

> 5 minutes
Give IV lorazepam
(Repeat once after 10 minutes if seizures reoccur or if fail)

> 25 minutes
Phenytoin or phenbarbital

> 45 minutes
Anesthesia w/ thiopental, midazolam or propofol

55
Q

when is Acetazolamide used in epilepsy?

A

when the epilepsy is associated with menstruation

56
Q

What is Clobazam and what is it used for?

A

A benzodiazepine.

used as adjunctive therapy in generalised tonic-clonic and refractory focal seizures.

57
Q

Zonisamide Indications

A

Focal seizures with or without secondary generalisation in adults with newly diagnosed epilepsy

58
Q

Valporic Acid Indications

A

Acute mania associated with bipolar disorder

59
Q

Sodium Valporate indications

A

Tonic Clonic seizures particularity in primary generalised epilepsy

focal seizures

Generalised absence seizures

60
Q

Sodium Valporate monitoring

A

LFTs and FBCs

61
Q

Topiramate Indications

A

Alone or as adjunctive treatment in generalised tonic-clonic seizures or focal seizures with or without secondary generalisation

Prophylaxis of migraine

62
Q

Rufinamide Indications

A

Adjunctive treatment of seizures in Lennox-Gastaut

63
Q

At risk groups for Flu Vaccine

A 
> 65 years
Pregnant
Diabetic
Heart Disease
Lung Disease
Kidney Disease
Neurological Disease
Weakened Immune System
64
Q

Referral Criteria for:

Cold and Flu

A 
if patient: 
has COPD
is Asthmatic 
is Immunocompromised
has chronic kidney and heart disease
65
Q

Difference between Cold and Flu

A

Cold
- gradual onset over 1 - 2 days lasting 7 - 14 days
(cough can persist for 2 weeks)

Flu
- Rapid onset of symptoms in hours - peak in winter
Fever | muscle/joint pain | Chills and Sweats

66
Q

FEV1/FVC ratio <0.7

A

Indicates airflow obstruction

67
Q

If FEV1:

< 30%

A

very severe COPD

68
Q

if FEV1:

30 - 49%

A

indicates severe COPD

69
Q

if FEV1:

50 - 80%

A

indicates moderate COPD

70
Q

if FEV1:

> 90%

A

Indicates mild COPD

71
Q

What is Desmopressin and when is it used?

A

A Vasopressin Analogue

used in the treatment of pituitary (Cranial) diabetes insipidus
and the differential diagnosis of diabetes insipidus

72
Q

Which is more potent?

Vasopressin or Desmopressin

A

Demopressin

73
Q

Which has a longer duration of action?

Vasopressin or Desmopressin

A

Desmopressin

74
Q

Which causes vasoconstriction?

Vasopressin or Desmopressin

A

Vasopressin

75
Q

How is the Flu treated?

A
  1. Rest, keep warm, drink plenty of fluids
  2. Take Paracetamol to lower fever
  3. Take Ibuprofen to relieve aches

N|B: Antibiotics are NOT required - Flu is viral not bacterial

  1. Antivirals to reduce symptoms/shorten duration
76
Q

When should antivirals for the Flu be started? and what are they?

A

Should be started within 2 days of flu symptoms for high risk groups

Tamiflu (Oseltamivir) BD 5 days
Relenza (Zanamivir) 2 puffs BD 5 days

77
Q

Seretide Evohaler

Whats in it?
Whos it for?

A

MDI of Fluticasone + Salmeterol
ICS + LABA

licenced for use in Asthma only

78
Q

Seretide Accuhaler

Whats in it?
Whos it for?

A

DPI of Fluticasone + Salmeterol
ICS + LABA

Seretide 100 & Seretide 250 licenced for asthma only

Seretide 500 is for both asthma and COPD

79
Q

Sybicort Turbohaler

Whats in it?
Whos it for?

A

DPI of Budesonide and Formoterol
ICS + LABA

100/6 licenced for asthma only

200/6 and 400/2 licenced for both asthma and COPD

80
Q

Fostair 100/6

Whats in it?
Whos it for?

A

MDI

Beclometasone + Formoterol

for asthma and COPD

81
Q

SIde Effects of Inhaled Steriods and how to prevent them

A
  • Hoarse voice
    Use a spacer
  • Oral Thrush (candidiasis)
    Rinse/gargle mouth with water after use
  • Reflex cough
    Inhale slowly/Use spacer
82
Q

What interacts with steriods?

A

Antieplictis
- Carbemazipine | Phenobarbital | Phenytoin

Antifungals
- Ampholericin | Ciclosporin

Antivirals
- Ritonavir

Vaccines

83
Q

SABA and LAMA interactions and side effects

A

increased risk of hypokalemia with:

  • Theophyline
  • Steroids
  • Diuretics

S/E:
hypokalemia | Tachycardia | Tremors | Anxiety

84
Q

Rescue Medication

A 
Oral antibiotics 
Amoxicillin 500 mg - 1 g TDS
or 
Clarythromycin 500 mg QDS
or
Doxycycline 200 mg on day 1 then 100 mg OD

AND

Oral Prednisolone 30 mg/day for 7 - 14 days

85
Q

Signs of well controlled asthma and COPD

A

no day/night symptoms

no limitation on activity

no exacerbation

no need for rescue medication

86
Q

Difference between asthma and COPD

A 
Asthma
Symptoms worse at night
There's usually a trigger
Good bronchodilator response
Wheezing on expiration 
Starts in children/infants
COPD
> 35
Smoker / Ex-smoker
SOB persistent and progressive
Poor bronchodilator response
87
Q

CSM Warning for Terfenadine

A

An antihistamine

Rare hazardous arrhythmias are associated with terfenadine particularly associated with increased blood concentration

Therefore:

  • Do not use more than the recommended dose
  • Avoid in significant hepatic impairment/hyperkalaemia
  • Avoid use with drugs that prolong QT interval/inhibit terfenadine metabolism
88
Q

Antihistamines

uses

A

For allergies

Reduce rhinorrhea and sneezing
(less useful for nasal congestion)

Good for urticaria

89
Q

Side Effects for Antihistamines

A

Dizziness | Drowsiness | Palpitations | Arrythmias | Hypotension | EPS | Hypersensitivity

90
Q

Antihistamine Cautions

A

Old antihistamines: Prostatic hypertrophy | Urinary Retention | Glaucoma | Pyloroduodenal obstructions

New antihistamines: Hepatic Impairment | Epilepsy | Children and the elderly

91
Q

Leukotriene Receptor Antagonists

Warning

A

Montelukast | Zafirlukast

Churg Strauss Syndrome has been associated with LRA use

In many cases reaction followed reduction/withdrawal of therapy.

Be alert to vasculitic rash, worsening pulmosary symptoms or cardiac complications

92
Q

Corticosteriods and Asthma

A

Very effective

Recommended for prophylaxis of asthma when patient is using SABA > 3x/week and has disturbed sleep > 1 week

Regular use < risk of exacerbations

Alleviation of symptoms 3 - 7 days

ORAL steroids are for acute asthma attacks

93
Q

Corticosteriods and COPD

A

May reduce exacerbations in COPD but no improvement in lung function

94
Q

Which is more effective in asthma?

Beclometasone
Budesonide
or
Fluticasone

A

TRICK QUESTION

They are equally effective

95
Q

Codeine and Coughing

A

for DRY cough

Will cause drowsiness and constipation. Limited use due to its additive nature

SHOULD NOT BE RECOMMENDED to patients

NOT TO BE SOLD TO < 18 years or breast feeding mothers

96
Q

Cause of clostridium difficile infection

A

Can be the result of antibiotic therapy.

Particularly with:

  • Ampicillin
  • Amoxicillin
  • Co-amoxiclav
  • 2nd and 3rd Generation Cephalosporins
  • Clindomycin
  • Quinolones
97
Q

Clostridium Difficile Treatment =

A

Metronidazole
Vancomycin
or
Fidaxomicin

98
Q

Antimuscarinic Side Effects

A

Constipation

Transient Bradycardia
(followed by tachycardia, palpitations and arrhythmias)

Reduced bronchial secretions

Urinary urgency and retention

Dilation of pupils with loss of accommodation

Photophobia

Dry mouth

Flushing/Dryness of skin

99
Q

Colestyramine interacts with..

A

Coumarins

BLACK DOT

100
Q

what the heck is Colestyramine used for, how is it taken and what are its effects?

A

Diarrhoea and Pruitus
4g OD

Its not absorbed in the GI tract. Binds to bile acids forming an insoluble complex in the intestine

However it interferes with the absorption of fat soluble vitamins (A, D, K ) and folic acid

Supplements may be needed

Other drugs taken 1hr before or 4 - 6 hrs after

101
Q

Ursodeoxycholic acid counselling point

A

Take at bed time or in divided doses (depending on weight)

Take WITH or AFTER food

May cause nausea, vomiting, diarrhoea

Avoid excess cholesterol and calories

Antacids decrease absorption so leave a 2 hour gap between

102
Q

Name some thiazide diuretics

A 
Bendroflumethiazide
Chlortalidone
Indapamide
Metolazone
Ximpamide
103
Q

Duration of action

Thiazide Diuretics

A

12 - 24 hours

104
Q

Ursodeoxycholic acid indication and side effects

A

Acts on the gall bladder to dissolve gall stones

Limitedd to use in patients where other techniques are ineffective

105
Q

Which beta blocker is safe for use in pregnancy?

A

Labetolol

106
Q

Name some Aminosalicylates

A

Mesalazine (must be prescribed by brand)
Sulfasalazine
Balsalazide

107
Q

Counselling points for Aminosalicylates

A

Report any unexplained bruising or bleeding, sore throat, fever or malaise (blood disorders)

Colours Urine ORANGE

Stains contact lenses

Mesalazine (must be prescribed by brand)
Sulfasalazine
Balsalazide

108
Q

Which PPI can be used in Pregnancy

A

omeprazole

109
Q

Misoprstol indication/dose

A

Benign Ulcers/NSAID associated ulcer

200mg QDS
for >18 years

Best for the elderly of frail where NSAIDs can’t be stopped

Can cause spontaneous abortion in pregnant women

Can cause severe diarrhoea - STOP

110
Q

Rivastigmine

indication and dose

A

Mild - moderate dementia (Alzheimers and Parkinsons)

Initially 1.5 mg BD increase every 2 weeks according to response and tolerence to 3- 6 mg BD

if treatment interrupted for more than several days, retitrate from 1.5 mg BD)

111
Q

High Compression bandages

A

Used for the management of gross varices, post thrombotic venous insufficiency, venous leg ulcers and gross oedema in average sized limbs

Their use calls for expert knowledge inappropriate application can be hazardous
(cause necrosis leading to amputation )

Doppler testing required before treatment with compression bandages

112
Q

Treatment of sinusitis

A

pain killer and decongestants

113
Q

Phenytoin counselling points

A
  • For the prevention of epileptic seizures NOT cure
  • Take WITH or AFTER food
  • Do not stop taking unless instructed by your doctor
  • If you get a fever or rash or mouth ulcer unexplained bruising or bleeding seek medical help
  • Can’t drive until seizure free for 1 year
114
Q

How to take Alginantes

A

take AFTER FOOD and all medication

Less effective when taken lying down, therefore H2 antagonists may be more effective for night time symptoms

115
Q

Tell me about Cardiac glycosides

A

Digoxin | Digitoxin

Used for heart failure | Supraventricular Arrythmias

S/E: nausea | vomiting | Diarrhoea | Dizziness | Blurred/Yellow Vision | Rash

Has a long half life

Renal function important for dosing

Special Care taken with the elderly

Beware of DIGITALIS TOXICITY

116
Q

True or False

Buprenorphine is only licenced as and adjunct in the treatment of opioid dependence?

A

FALSE

Also licensed for premeditation
Intra-operative analgesia
Moderate - Severe pain

117
Q

Centrally acting anti-hypertensives

A

Clonidine | Methyldopa | Monoxidine

Licenced for mild to moderate hypertention when thiazides, beta blocker, ACEi and CCBs are not appropriate or have failed to control BP

118
Q

How can we reduce the risk of dependence on Benzodiazepines?

A
  • use short course treatment (2 - 4 weeks only)

- Only used for severe and disabling conditions or for patients in extreme distress

119
Q

what type of dependence is it for a patient on daily diazepam?

A

physical and psychological

120
Q

True or false

Subcutaneous diamorphine is preferred to IM morphine in palliative care

A

TRUE

diamorphine is more soluble than morphine and can be given in a smaller volume

Pharmacy Prep (25 decks)

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