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MRCEM Primary Exam > Lyfjafræði II > Flashcards

Lyfjafræði II Flashcards

1
Q

6 ábendingar fyrir digifab í akút digital eitrun:

A
  • Cardiac arrest
  • Life-threatening arrhythmia
  • Potassium level > 5 mmol/l
  • > 10 mg digoxin ingested (adult)
  • > 4 mg digoxin ingested (child)
  • Digoxin level > 12 ng/ml
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2
Q

4 ábendingar fyrir digifab í krónískri digitalis eitrun:

A
  • Cardiac arrest
  • Life-threatening arrhythmia
  • Significant gastrointestinal symptoms
  • Symptoms of digoxin toxicity and coexistent renal failure
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3
Q

Hvernig virka prótínpumpuhemlar eins og omeprazol?

A

Proton pump inhibitors, such as omeprazole, work by irreversibly blocking the hydrogen/potassium ATPase proton pump of the gastric parietal cells. The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H+ ions into the gastric lumen.

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4
Q

HVer er algengasta aukaverkun sodium valproate?

A

Postural tremor is the most common neurological side effect observed with sodium valproate.

A resting tremor can also occur. Approximately 25% of patients taking sodium valproate are found to develop a tremor with 12 months of starting therapy.

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5
Q

Dæmi um aukaverkun af lithium sem allt að 50% einstaklinga fá á fyrstu vikunni en minnkar svo hjá flestum:

A

The development of a fine hand tremor is very commonly seen with lithium prescribing. It is quoted as occurring in as many as 50% of patients during the first week of therapy. The tremor has a tendency to reduce over time and is only present in around 5% of patients that have been taking the medication for 2 years or longer.

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6
Q

Olanzapine, quetiapine, carbamazepine - hvert af þessum 3 veldur ekki handtremor?

A

Carbamazepine

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7
Q

Hvað má líða langur tími frá stroke og þar til einstaklingur fær alteplase?

A

The SIGN guidelines recommend that patients admitted with stroke within four and a half hours of definite onset of symptoms, who are considered suitable, should be treated with 0.9 mg/kg (up to a maximum of 90 mg) intravenous rt-pA (aletplase).

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8
Q

Hvernig virkar sotalol?

A

Blocks beta-adrenoreceptors and K+ channels, reducing heart rate and slowing conduction in the AV node. Also prolongs phase 3 of cardiac action potential.

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9
Q

Hvernig virkar adenosine?

A

Opens K+ channels in heart, slowing conduction in the AV node

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10
Q

Hvernig virkar amiodarone?

A

Blocks Na+ and K+ channels and beta-adrenoreceptors, prolonging phase 3 of cardiac action potential and slowing conduction at SA and AV nodes

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11
Q

Hvernig virkar digoxin?

A

Inhibits the Na/K ATPase in cardiac myocytes

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12
Q

Hvernig virkar flecainide?

A

Blocks Na+ channel in heart, slowing conduction of the cardiac impulse

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13
Q

Hvernig virkar lidocain sem arrythmiulyf?

A

Blocks Na+ channels in heart, slowing conduction of the cardiac impulse

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14
Q

Hvernig virkar verapamil?

A

Blocks Ca2+ channels in heart, slowing conduction in the AV node

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15
Q

Benzo antidote:

A

Flumazenil

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16
Q

3 antidote við beta blokkerum:

A

Atropine
Glucagon
Insulin

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17
Q

Antidote við carbon monoxide:

A

Súrefni

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18
Q

3 antidote við cyanide:

A

Hydroxocobalamin
Sodium nitrite
Sodium thiosulphate

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19
Q

2 antidote við ethylene glycol:

A

Ethanol

Fomepizole

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20
Q

Antidote við heparíni:

A

Protamine sulphate

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21
Q

Antidote við iron salts:

A

Desferrioxamine

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22
Q

Antidote við isoniazide:

A

Pyridoxine

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23
Q

Antidote við methanol:

A

Ethanol

Fomepizole

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24
Q

Antidote við organophosphates:

A

Atropine

Pralidoxime

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25
Q

2 antidote við paracetamóli:

A

Acetylcysteine

Methionine

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26
Q

2 antidote við sulfonyl urea:

A

Glucose

Octreotide

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27
Q

Antidote við thallium:

A

Prussian blue

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28
Q

2 antidote við warfarin:

A

Vitamin K

Fresh frozen plasma (FFP)

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29
Q

Prednisolone er X sinnum sterkara en hydrocortison:

A

4x

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30
Q

Triamcinolone er X sinnum sterkara en hydrocortison:

A

5x

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31
Q

Methylprednisolone er X sinnum sterkara en hydrocortison:

A

5x

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32
Q

Dexamethasone er X sinnum sterkara en hydrocortison:

A

25x

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33
Q

Hvernig lyf er verapamil og til hvers er það notað?

A

Verapamil is a calcium channel-blocker used in the treatment of hypertension, angina, cardiac arrhythmias and most recently, cluster headaches.

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34
Q

5 aukaverkanir verapamil:

A
  • Dizziness
  • Flushing
  • Nausea and vomiting
  • 1st and 2nd degree heart block
  • Precipitation of heart failure in patients with impaired ventricular function
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35
Q

Hvernig virkar verapamil?

A

Verapamil acts by blocking L-type calcium channels and has particularly powerful effects on the atrioventricular node (AV node), where conduction is entirely dependent on calcium spikes. It also inhibits the influx of Ca2+ during the plateau phase of the action potential and therefore has a negatively inotropic effect.

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36
Q

Verapamil skammtar:

A

The adult oral dose of verapamil is 240-480 mg in 2-3 divided doses. The corresponding intravenous (IV) dose is 5-10 mg administered over 30 seconds. The peak effect after IV injection occurs at 3-5 minutes and the duration of action is 10-20 minutes.

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37
Q

7 einkenni digoxin eitrunar:

A
  • Nausea and vomiting
  • Diarrhoea
  • Abdominal pain
  • Confusion
  • Tachyarrhythmias or bradyarrhythmias
  • Xanthopsia (yellow-green vision)
  • Hyperkalaemia (early sign of significant toxicity)
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38
Q

6 lyf sem geta gert digoxin eitrun líklegri:

A
  • Spironolactone
  • Amiodarone
  • Quinidine
  • Verapamil
  • Diltiazem
  • Drugs causing hypokalaemia e.g. thiazide and loop diuretics
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39
Q

9 atriði sem gera einstaklinga veikari fyrir því að fá digoxin eitrun:

A
  • Elderly patients
  • Renal failure
  • Myocardial ischaemia
  • Hypokalaemia
  • Hypomagnesaemia
  • Hypercalcaemia
  • Hypernatraemia
  • Acidosis
  • Hypothyroidism
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40
Q

Hver er skammtur per kg af aletplase?

A

The SIGN guidelines recommend that patients admitted with stroke within four and a half hours of definite onset of symptoms, who are considered suitable, should be treated with 0.9 mg/kg (up to a maximum of 90 mg) intravenous rt-pA (aletplase).

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41
Q

3 lyf sem hægt er að nota í bacteríal conjunctivit:

A
  • Chloramphenicol 0.5% drops (apply 1 drop 2 hourly for 2 days then 4 times daily for 5 days)
  • Chloramphenicol 1% ointment (apply four times daily for 2 days, then twice daily for 5 days)
  • Fusidic acid 1% eye drops (can be used second-line, apply twice daily for 7 days)
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42
Q

Hvernig virkar warfarin?

A

Warfarin inhibits the synthesis of vitamin K dependent clotting factors II, VII, IX and X. It also inhibits the synthesis of the regulatory factors protein C, protein S and protein Z.

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43
Q

Dæmi um lyf sem er EKKI með significant first pass metabolism:

A

First-pass metabolism is a phenomenon whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation due to hepatic metabolism. As a consequence an oral dose much larger than an equivalent parenteral dose is required, or in some cases oral administration is precluded.

The first-pass metabolism of bisoprolol is not significant and is less than 20%.

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44
Q

10 lyf sem hafa significant first pass metabolism:

A
  • Aspirin
  • Glyceryl trinitrate
  • Propranolol
  • Verapamil
  • Hydrocortisone
  • Testosterone
  • Isoprenaline
  • Lidocaine
  • Morphine
  • Diazepam
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45
Q

Hep A bóluefnið er dæmi um hvernig bóluefni?

A

Killed virus (inactivated virus)

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46
Q

Bóluefni koma í 4 týpum:

A

Live-attenuated vaccines
Inactivated vaccines
Subunit vaccines
Toxoid vaccines

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47
Q

6 dæmi um live-attenuated bóluefni:

A
  • Measles, mumps and rubella vaccines (MMR)
  • Oral polio vaccine (OPV)
  • Smallpox vaccine
  • Yellow fever vaccine
  • Chickenpox vaccine
  • Rotavirus vaccine
48
Q

3 dæmi um inactivated bóluefni:

A

Hepatitis A vaccine
Inactivated polio vaccine (IPV)
Rabies vaccine

49
Q

5 dæmi um subunit vaccines:

A
  • Haemophilus influenzaetype b (Hib) vaccine
  • Hepatitis B vaccine
  • Human papillomavirus (HPV) vaccine
  • Pneumococcal vaccine
  • Meningococcal vaccine
50
Q

Hvernig virka subunit vaccines?

A

Subunit vaccines use a very small part of an organism that has been selected for its ability to initiate a specific immune response, which is then isolated and purified. Because these vaccines use only a specific piece of the organism, they tend to generate a very strong immune response that is targeted against this key part of the organism.

51
Q

2 dæmi um toxoid vaccines:

A 
Diphtheria toxoid vaccine
Tetanus toxoid (TT) vaccine
52
Q

Hverjir eiga að fá prophylaktiskt varizella zoster immunoglobulin?

A

Prophylactic VZIG is recommended for high-risk patients (t.d. ófrískar konur, nýburar, þeir sem taka háa steraskammta, ónæmisbældir) with no known immunity (i.e. no known previous chickenpox) who have had a significant exposure to varicella zoster (considered > 4 hours close contact).

53
Q

Hvað er anti-D?

A

Anti-D is an IgG class antibody directed against the Rhesus D (RhD) antigen.

54
Q

Hvaða konur eiga að fá Anti-D og af hverju?

A

Anti-D is only given to RhD negative women. RhD negative women do not carry the RhD antigen on their RBC. If a fetus does carry the RhD antigen (i.e. is RhD positive) and the mother is exposed to fetal blood, she may form antibodies to RhD that pass through the placenta to attack fetal red cells (causing haemolytic disease of the newborn) in this or subsequent pregnancies. Anti-D is given to bind fetal red cells in the maternal circulation to neutralise them before an immune response is triggered.

55
Q

Hvaða hluti af hepatitis B veirunni er í hep B bóluefninu? Hvaða antibody fær maður eftir bólusetninguna?

A

The hepatitis B vaccine contains the viral envelope protein, hepatitis B surface antigen (HBsAg). Vaccination results in the generation of the antibody anti-HBsAg.

56
Q

Hep B bólusetningar: hvað eru margar sprautur og á hversu margra mánaða fresti? Hvenær þarf að mæla blóðtítra og hvað þurfa þeir að vera háir?

A

The UK course is three injections of the hepatitis B vaccine over a 6-month period. Blood titres are taken one month after the third dose of the vaccine and levels above 100 mIU/ml is regarded as adequate. This generally provides immunity for at least 5 years. At 5 years after the initial injection a booster can be given.

57
Q

Hvaða bóluefni mega miltislausir einstaklingar fá?

A

Öll - bæði lifandi og inactivated bóluefni.

58
Q

5 contraindicationir fyrir lifandi bóluefnum:

A
  • Pregnancy
  • HIV, whether asymptomatic or symptomatic
  • If less than 3 weeks after another live vaccine (although 2 live vaccinations can be given together at different sites of the body)
  • Other illnesses causing severe compromise of the immune system
  • Haematological malignancies
59
Q

Hvenær er hægt að gefa hep B immunoglobulin eftir high risk exposure?

A

Hepatitis B immunoglobulin can be given up to 7 days after high-risk exposure. Ideally immunoglobulin should be given within 12 hours but the BNF recommends use up to 7 days after exposure.

60
Q

Er bólusetning við kíghósta (pertussis) ráðlögð á meðgöngu og hvers vegna/ekki?

A

Pertussis vaccination is now recommended for pregnant patients due to the high complication rates of whooping cough in pregnancy.

61
Q

Contra indicationir gegn gjöf tetanus toxoid:

A

Febrile illness is only a precaution and not a contraindication to the administration of tetanus toxoid. Anaphylaxis or encephalopathy following previous doses are the only contraindications.

62
Q

3 dæmi um antihistamín ógleðilyf:

A

Cyclizine
Promethazine
Cinnarizine

63
Q

3 dæmi um dopamine receptor antagonists ógleðilyf:

A

Domperidone
Metoclopramide
Prochlorperazine

64
Q

1 dæmi um antimuscarinic ógleðilyf:

A

Hyoscine

65
Q

2 dæmi um 5-HT3 receptor antagonist ógleðilyf:

A

Ondansetron

Granisetron

66
Q

Dæmi um eitt neurokinin receptor antagonist ógleðilyf:

A

Aprepitant

67
Q

Hvers konar lyf er diltiazem?

A

Calcium-channel blocker

68
Q

Hvaða tvo calcium gangnablokka er hættulegast að overdosa á?

A

The two most lethal types of calcium channel blockers in overdose are verapamil and diltiazem.

69
Q

Hvernig virka calcium gangna blokkerarnir diltiazem og verapamil? Hvaða frumur koma sérstaklega við sögu?

A

These act by binding alpha-1 subunit of L-type calcium channels, thereby preventing the intracellular influx of calcium. These channels are functionally important in cardiac myocytes, vascular smooth muscle cells, and islet beta-cells.

70
Q

8 skref í endurlífgun/meðferð eftir calcium ganga blokka overdose:

A
  1. Fluid resuscitation:
    Give up to 20 mL/kg of crystalloid
  2. Calcium administration
    This can be a useful temporising measure to increase blood pressure and heart rate.
    10% calcium gluconate 60 mL IV (0.6-1.0 mL/kg in children), or;
    10% calcium chloride 20 mL IV (0.2 mL/kg in children) via central venous access
    Repeat boluses can be given up to 3 times
    Consider calcium infusion to keep serum calcium >2.0 mEq/L
  3. Atropine:
  4. 6 mg every 2 min up to 1.8 mg can be considered but is frequently ineffective
  5. High dose insulin – euglycaemic therapy (HIET):
    The place of HIET in the step-wise approach to managing cardiovascular toxicity has evolved
    This used to be considered a last-ditch measure, but early use is now being increasingly advocated
    Short-acting insulin 1 U/kg bolus plus 50 mL of 50% glucose IV bolus (unless marked hyperglycaemia present)
    Continue therapy with short-acting insulin/dextrose infusion
    Monitor glucose every 20 minutes for the first hour and then hourly
    Monitor potassium levels regularly and replace if < 2.5 mmol/L
  6. Vasoactive infusions:
    Titrate catecholamines to effect (inotropy and chronotropy); options include dopamine, adrenaline and/ or noradrenaline
  7. Sodium bicarbonate:
    Consider using in cases where a severe metabolic acidosis develops
    50-100 mEq sodium bicarbonate (0.5-1.0 mEq/kg in children)
  8. Cardiac pacing:
    Electrical capture can be challenging to achieve and may not improve overall perfusion
    Use ventricular pacing to bypass AV blockade, typical with rates not in excess of 60/min
  9. Intralipid
    Consider using in refractory cases, as calcium channel blockers are lipid-soluble agents
71
Q

Hvernig á að gefa kalk í calcium ganga blokka overdose og hvað á að gera fyrst?

A

Fyrst á að gefa 20ml/kg af crystalloid vökva. Ef það dugar ekki til að hækka blþr skal gefa calcium:
Calcium administration
This can be a useful temporising measure to increase blood pressure and heart rate.
- 10% calcium gluconate 60 mL IV (0.6-1.0 mL/kg in children), or;
- 10% calcium chloride 20 mL IV (0.2 mL/kg in children) via central venous access
- Repeat boluses can be given up to 3 times
- Consider calcium infusion to keep serum calcium >2.0 mEq/L

72
Q

Dæmi um lyf þar sem samheitalyf virkar ekki eins og originallinn:

A

theopylline

73
Q

Hver eru meðferðarmörk theopylline í blóði?

A

It is advised that serum levels of 10-20 mg/l four to six hours after the last tablet should be aimed for.

74
Q

4 atriði sem lengja helmingunartíma theophylline:

A

Heart failure
Cirrhosis
Viral infection
Ýmis lyf

75
Q

3 þættir sem stytta helmingunartíma theophylline:

A

Smoking
Heavy drinking
Ýmis lyf

76
Q

6 dæmi um lyf sem lengja helmingunartíma theophyllin:

A
  • Calcium channel blockers, e.g. Verapamil
  • Cimetidine
  • Fluconazole
  • Macrolides, e.g. erythromycin
  • Quinolones, e.g. ciprofloxacin
  • Methotrexate
77
Q

6 dæmi um lyf sem stytta helmingunartíma theophylline:

A
  • Barbiturates
  • Carbamazepine
  • Phenobarbitol
  • Phenytoin (and fosphenytoin)
  • Rifampicin
  • St. John’s wort
78
Q

Dæmi um 2 aukaverkanir berklalyfja og hvernig má koma í veg fyrir aðra þeirra:

A
  • Isoniazid, rifampicin and pyrazinamide are all known to be hepatotoxic.
  • Also, isoniazid causes increased excretion of pyridoxine, thereby leading to its deficiency, giving rise to symptoms of peripheral neuropathy and sideroblastic anaemia.
  • Therefore, all patients started on isoniazid should be supplemented with vitamin B6 (pyridoxine).
79
Q

Allir sj sem taka isoniazid ættu líka að taka…

A

…B6 vítamín

80
Q

Hvernig virkar digoxin?

A

Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes a positive inotropic effect and a negative chronotropic effect.

81
Q

11 frábendingar fyrir nítró:

A
  • Aortic stenosis
  • Cardiac tamponade
  • Constrictive pericarditis
  • Hypertrophic cardiomyopathy
  • Hypotensive conditions
  • Hypovolaemia
  • Marked anaemia
  • Mitral stenosis
  • Raised intracranial pressure due to cerebral haemorrhage
  • Raised intracranial pressure due to head trauma
  • Toxic pulmonary oedema
82
Q

Meðferð við symptomatiskri levoxin eitrun: (fyrir utan ABC og kol ef inntaka yfir 10mg og innan 1 klst):

A

Treatment is generally supportive and is aimed at the management of the sympathomimetic features associated with levothyroxine overdose. Options include propranolol 10-40 mg PO 6 hourly or diltiazem 60-180 mg 8 hourly if beta blockers are contra-indicated

83
Q

4 dæmi um 1. kynslóðar anti-psykotika lyf:

A

Chlorpromazine
Haloperidol
Fluphenazine
Trifluoperazine

84
Q

5 dæmi um 2. kynslóðar anti-psykotika lyf:

A 
Clozapine
Olanzapine
Quetiapine
Risperidone
Aripiprazole
85
Q

Hver er munurinn á 1. og 2. kynslóðar anti-psykotika lyfjum?

A

The first-generation (conventional or typical) antipsychotics are strong dopamine D2 receptor antagonists. However, each drug in this class has various effects on other receptors, such as serotonin type 2 (5-HT2), alpha1, histaminic, and muscarinic receptors. They are more likely to cause a range of side effects, particularly acute extrapyramidal symptoms, including rigidity, bradykinesia, dystonias, tremor, and akathisia. Tardive dyskinesia, which is involuntary movements in the face and extremities, is another adverse effect that can occur with first-generation antipsychotics. Neuroleptic malignant syndrome (NMS) can also occur with these agents. They are also more likely to cause hyperprolactinaemia.

Second-generation (novel or atypical) antipsychotics, with the exception of aripiprazole, are also dopamine D2 antagonists but act on a greater range of receptors in comparison to the first-generation antipsychotic drugs. They are generally associated with a lower risk for acute extrapyramidal symptoms and tardive dyskinesia. However, second-generation antipsychotic drugs are associated with higher rates of other important adverse effects, such as weight gain and glucose intolerance. Second-generation antipsychotics are also more likely to cause anticholinergic side effects.

86
Q

Hvers konar aukaverkanir eru algengar fyrir 1. kynslóðar anti-psykotika?

A

Particularly acute extrapyramidal symptoms, including rigidity, bradykinesia, dystonias, tremor, and akathisia. Tardive dyskinesia, which is involuntary movements in the face and extremities, is another adverse effect that can occur with first-generation antipsychotics. Neuroleptic malignant syndrome (NMS) can also occur with these agents. They are also more likely to cause hyperprolactinaemia.

87
Q

Á hvaða viðtaka virka 1. kynslóðar anti-psykotika?

A

The first-generation (conventional or typical) antipsychotics are strong dopamine D2 receptor antagonists. However, each drug in this class has various effects on other receptors, such as serotonin type 2 (5-HT2), alpha1, histaminic, and muscarinic receptors.

88
Q

Á hvaða viðtaka virka 2. kynslóðar anti-psykotika?

A

Second-generation (novel or atypical) antipsychotics, with the exception of aripiprazole, are also dopamine D2 antagonists but act on a greater range of receptors in comparison to the first-generation antipsychotic drugs

89
Q

Hvaða aukaverkanir eru algengar fyrir 2. kynslóðar anti-psykotika?

A

Second-generation antipsychotic drugs are associated with higher rates of other important adverse effects, such as weight gain and glucose intolerance. Second-generation antipsychotics are also more likely to cause anticholinergic side effects.

90
Q

Hvaða lyf er eina 2. kynslóðar anti-psykotika lyfið sem EKKI virkar með sterkri D2 dópamín antagonista verkun?

A

Aripiprazole

91
Q

Ef sj. þarf NSAIDS og uppfyllir skilmerki um að þurfa magasýruhemil með, hvaða hemill er fyrsta val? (2)

A

Either omeprazole 20 mg daily or lansoprazole 15-30 mg daily should be the PPIs of choice.

92
Q

Hver er hámarks dagskammtur ibuprofens?

A

2,4g

93
Q

Hvaða sjúklingar þurfa að fá magasýruhemil meðfram notkun NSAIDS lyfja?

A

The current recommendations by NICE suggest that gastro-protection should be considered if patients have ≥1 of the following:

  • Using maximum recommended dose of an NSAID
  • Aged 65 or older
  • History of peptic ulcer or GI bleeding

Concomitant use of medications that increase risk:

  • Low dose aspirin
  • Anticoagulants
  • Corticosteroids
  • Anti-depressants including SSRIs and SNRIs

Requirements for prolonged NSAID usage:

  • Patients with OA or RA at any age
  • Long-term back pain if older than 45
94
Q

Við hverju eru þríhringlaga þunglyndislyf notuð?

A

Tricyclic antidepressants (TCAs) are mainly used in the treatment of depression but are also used in the treatment of anxiety disorders, chronic pain conditions and attention-deficit hyperactivity disorder (ADHD).

95
Q

Hvernig virka TCA þunglyndislyf?

A

The majority of TCAs act primarily as serotonin-noradrenaline reuptake inhibitors (SNRIs) by blocking the serotonin transporter (SERT) and the noradrenaline transporter. This results in an elevation in the synaptic concentrations of serotonin and noradrenaline, and therefore an enhancement of neurotransmission.

96
Q

Með hvaða lyfjaflokki geðlyfja má EKKI nota TCA þunglyndislyf?

A

TCAs should not be used concomitantly with monoamine oxidase inhibitors (MAOIs), such as selegiline, and should be started at least two weeks after stopping the MAOI. There is a risk of developing serotonin toxicity if the two drug classes are used together.

97
Q

Geta TCA þunglyndislyf valdið serotonin sx?

A

Serotonin syndrome may occur with TCA overdose. Features of this syndrome include CNS effects (including agitation and coma), autonomic instability (including hyperpyrexia) and neuromuscular excitability (including clonus and raised serum creatine kinase).

98
Q

Frábending fyrir notkun TCA þunglyndislyfja:

A
  • Acute porphyria
  • Arrhythmias
  • During the manic phase of bipolar disorder
  • Heart block
  • Immediate recovery period after myocardial infarction
99
Q

Erythromycin er dæmi um hvernig sýklalyf?

A

Macrolide

100
Q

Getur lithium orsakað syndrome of inappropriate antidiuresis?

A

Nei.

101
Q

11 einkenni um lithium eitrun:

A
  • Ataxia
  • Clonus
  • Coma
  • Confusion
  • Convulsions
  • Diarrhoea
  • Increased muscle tone
  • Nausea and vomiting
  • Nephrogenic diabetes insipidus
  • Renal failure
  • Tremor
102
Q

Hvaða áhrif getur trimetoprim haft á 1. trimester meðgöngu og hver er mekanisminn?

A

The use of trimethoprim in the 1st-trimester is associated with an increased risk of neural tube defects due to folate antagonism. If an alternative antibiotic is not possible, it is recommended that pregnant women taking trimethoprim also take high dose folic acid. The use of trimethoprim in the 2nd- and 3rd-trimesters of pregnancy is considered safe.

103
Q

Hvaða sjúklinga þarf að meta mtt þarfar á heimasúrefni?

A

Long-term administration of oxygen (usually at least 15 hours daily) improves survival in chronic obstructive pulmonary disease (COPD) patients with more severe hypoxaemia. The need for oxygen should be assessed in COPD patients with an FEV1 less than 30% predicted (consider assessment if FEV1 is 30-49%), cyanosis, polycythaemia, peripheral oedema, raised JVP, and when oxygen saturation levels are 92% or less breathing air.

Assessment for long-term oxygen therapy requires measurement of arterial blood gas tensions. Measurements should be taken on 2 occasions at least 3 weeks apart to demonstrate clinical stability.

104
Q

Hjá hvaða sjúklingahópum eru ábendingar fyrir heimasúrefni?

A

Long-term oxygen therapy should be considered for patients with:

  • COPD with PaO2 <7.3 kPa when stable and who do not smoke (minimum of 15 hours per day)
  • COPD with PaO2 7.3–8 kPa when stable and do not smoke, and also have either secondary polycythaemia, peripheral oedema, or evidence of pulmonary hypertension (minimum of 15 hours per day)
  • Severe chronic asthma with PaO2 <7.3 kPa or persistent disabling breathlessness
  • Interstitial lung disease with PaO2 <8 kPa and in patients with PaO2 >8 kPa with disabling dyspnoea
  • Cystic fibrosis when PaO2 <7.3 kPa or if PaO2 7.3–8 kPa in the presence of secondary polycythaemia, nocturnal hypoxaemia, pulmonary hypertension, or peripheral oedema
  • Pulmonary hypertension, without parenchymal lung involvement when PaO2 <8 kPa
  • Neuromuscular or skeletal disorders, after specialist assessment
  • Obstructive sleep apnoea despite continuous positive airways pressure therapy, after specialist assessment
  • Pulmonary malignancy or other terminal disease with disabling dyspnoea
  • Heart failure with daytime PaO2 <7.3 kPa when breathing air or with nocturnal hypoxaemia
  • Paediatric respiratory disease, after specialist assessment.
105
Q

Hvernig virkar verapamil?

A

The two most lethal types of calcium channel blockers in overdose are verapamil and diltiazem. These act by binding alpha-1 subunit of L-type calcium channels, thereby preventing the intracellular influx of calcium. These channels are functionally important in cardiac myocytes, vascular smooth muscle cells, and islet beta-cells.

106
Q

Hvenær á að gefa adrenalín í endurlífgun með stuðanlegum takti?

A

Adrenaline should be given after the 3rd shock in a shockable (Vf/pVT) cardiac arrest once chest compressions have resumed. The dose is 1 mg (10 mL of 1:10,000 or 1 mL of 1:1000)

It should subsequently be given every 3-5 mins (i.e. alternate loops), and it should be given without interrupting chest compressions.

107
Q

4 flokkar af lyfjum sem geta stuðlað að hækkuðum blóðsykri:

A
  • Thiazide diuretics, e.g. bendroflumethiazide
  • Loop diuretics, e.g. furosemide
  • Steroids, e.g. prednisolone
  • Beta-blockers, e.g. atenolol
108
Q

Hvernig virkar tenecteplase

A

Tenecteplase is a tissue plasminogen activator (tPA). It selectively binds to fibrin and converts plasminogen to plasmin, resulting in the degradation of the fibrin matrix and reperfusion.

It is the only drug given in the options above that primarily acts by reperfusion of the affected site.

109
Q

Hvers vegna getur amiodarone valdið brenglunum á skjaldkirtli? Hvort er algengara að það sé hypo eða hyperthyroidismi?

A

Amiodarone chemically resembles thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, although hypothyroidism is far more common, occurring in 5-10% of patients.

110
Q

Hvernig virkar aspirin?

A

Aspirin acts via the irreversible inhibition of cyclo-oxygenase, which results in a reduction in the production of prostaglandin and thromboxane. This consequently reduces platelet activation and aggregation.

111
Q

Hvernig virkar verapamil og við hverju er það notað (3)?

A

Verapamil is a non-dihydropyridine calcium-channel blocker often used as an anti-arrhythmic and anti-anginal. It is both negatively inotropic and negatively chronotropic.

It can be used in the management of both atrial flutter and atrial fibrillation. It is also used in the prophylaxis of paroxysmal supraventricular tachycardias.

112
Q

10 frábendingar fyrir notkun verapamils:

A
  • Acute porphyrias
  • Atrial flutter or fibrillation associated with accessory conducting pathways (e.g. Wolff-Parkinson-White-syndrome)
  • Bradycardia
  • Cardiogenic shock
  • Heart failure (with reduced ejection fraction)
  • History of significantly impaired left ventricular function (even if controlled by therapy)
  • Hypotension (SBP <90 mmHg)
  • Second- and third-degree AV block
  • Sick sinus syndrome
  • Sino-atrial block
113
Q

5 frábendingar fyrir notkun mannitols:

A

Anuria
Intracranial bleeding (except during craniotomy)
Severe cardiac failure
Severe dehydration
Severe pulmonary oedema

114
Q

Skammtar fyrir mannitol

A

The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2 g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.

115
Q

5 tegundir langvirks insúlíns:

A

protamine zinc insulin (gamalt, sjaldan notað)
insulin zinc suspension (gamalt, sjaldan notað)
insulin detemir
insulin glargine
insulin degludec

116
Q

Virknitími atracurium og annarra non-depolarizing neuromuscular lyfja fyrir intubation er LENGDUR af þessum 7 hlutum:

A

Hypokalaemia
Hypocalcaemia
Hypermagnesaemia
Hypoproteinaemia
Dehydration
Acidosis
Hypercapnia

MRCEM Primary Exam (21 decks)

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