Metabolic/ pharm Flashcards
widespread muscle cramps and numbness of her hands and feet. She also describes a tingling sensation around her mouth.. CX?
low Ca: vitamin D deficiency (osteomalacia)
chronic kidney disease
hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
rhabdomyolysis (initial stages)
magnesium deficiency (due to end organ PTH resistance)
massive blood transfusion
acute pancreatitis (and lleads to long QT)
Vitamin D deficieny TX?
Less than 25 nmol/L – vitamin D deficiency
25 to 50 nmol/L – vitamin D insufficiency
50,000 IU once weekly for 6 weeks
4000 IU daily for 10 weeks
Maintenance: 800-2000IU OD
Squamous cell carcinoma (skin) af?
Increased PTH (
Small cell lung cancer AF?
SIADH,
SmAALl cell lung cancer:
ACTH
ADH
Lambert Eaton syndrome (antibodies against VGCCs)
High K causes?
acute kidney injury
drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
metabolic acidosis
Addison’s disease
rhabdomyolysis
massive blood transfusion
Foods that are high in potassium:
salt substitutes (i.e. Contain potassium rather than sodium)
bananas, oranges, kiwi fruit, avocado, spinach, tomatoes
tall-tented T waves, small P waves, widened QRS
when do u sus familial hypercholesterolaemia
TC 7.5+, FH of IHD/ CAD before age of 60. test in children at 5 YO if both parents have it, test at 10 YO if 1 parent has it. tendon xanthoma in patients/ 1st degree
SE/ CI of sildenafil? (phosphodiesterase V inhibitor)?
Neonates - sed for pulmonary hyptertension
CI: nitrates, nicorandil, hyptension, stroke/ mI in 6 months
SE: visual disturbances
blue discolouration
non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism
Gentamycin (aminoglycoside) Risks?
CI: myasthenia gravis
Risks: ototoxic, nephrotoxic, aKI
Organophosphate poisoning? Sx? TX?
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation
Tx: atropine
Prescipitate lithium toxicity (DAMN)?
Diuretics
Ace/ARB
Metronidazole
NSAIDs
tox when 1.5+ (normal 0.4-1)
blurry vision, halos around lights, and yellow-green colour perception (xanthopsia)? Which toxicity? Triggering factors?
digoxin. aldo gynacomastia, AV block, brady.
Triggers: low K, low Mg, High Ca, High NA, myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
Headache, N_V, fever, vertigo, pink skin, confusion, extrapyramidal features?
Carbon monoxide poisoning:
typical carboxyhaemoglobin levels
< 3% non-smokers
< 10% smokers
TX: 100
Low MG Cx?
PPI, TPN
diuretics
total parenteral nutrition
alcohol
hypokalaemia
hypercalcaemia
Gitleman’s and Bartter’s
>0.4 - oral
<0.4 + seizures/tetany give IV
Triggers of digoxin tox?
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
Paracetamol OD - when to give Acetylcystine
100 mg/L at 4 hours and 15 mg/L at 15 hours, or
staggered
- 8-24 hours after ingestion over 150 mg/kg
24hrs after presentation with clear jaundiced a and derranged LFTs
Paracetamol OD - when to consider transplant
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
Chest pain with hypertonic and hyper-reflexive, and his pupils are dilated. His blood pressure is 175/82 mmHg. An ECG shows some QRS widening and QT prolongation, as well as ST depression and T wave inversion in several leads.
MI after cocaine injestion. Give diazepam (caused by coronary vasospasm, benzos smooth muscle relax)
Fe OD tx?
Desferrioxamine, a chelating agent
Cyanide poisoning TX?
Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
Lead poisoning TX?
Dimercaprol, calcium edetate
Drugs to avoid in renal failure?
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
Mixed metabolic acidosis/ tinnitus, lethargy, pyrexia, N+V, seizures, hyperventilation, BM erratic
Salicylate poisoning:
Tx: charcoal, urine alkalisation IV HCO3, haemodialisis (if 700+)
Cx of lung fibrosis?
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
Drug induced thrombocytopenia?
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
