Passmed Pharm Mushkies Flashcards
1
Q
Diclofenac C/I?
A
Any form of cardiovascular disease
2
Q
Best CVS profiles of the NSAIDs?
A
Naproxen and low-dose ibuprofen
3
Q
S/e of spinal anaesthesia?
A
- Hypotension
2. Sensory and motor block, nausea, urinary retention
4
Q
C/I of epidural anaesthesia?
A
- Confine pt to bed
- Catheter required
- Infection
- Epidural haematoma
5
Q
Morphine metabolism?
A
Liver
6
Q
Pethidine potency?
A
10% of morphine
7
Q
Neuropathic pain mx?
A
- Amitryptiline or Pregabalin
- Amitryptiline AND pregabalin
- Pain specialist with tramadol in the interim
8
Q
Diabetic neuropathic pain mx?
A
Duloxetine
9
Q
Amiodarone-induced hypothyroidism?
A
Thought to be due to the high iodine content of amiodarone causing a Wolff-Chaikoff effect
10
Q
Amiodarone-induced thyrotoxicosis types?
A
- AIT Type I = excess iodine induced thyroid hormone synthesis, goitre present
- AIT Type II = amiodarone related destructive thyroiditis, goitre absent
11
Q
Mx of AIT Type I?
A
Carbimazole or potassium perchlorate
12
Q
Mx of AIT Type II?
A
Corticosteroids
13
Q
Wolff-Chaikoff effect?
A
An autoregulatory phenomenon where thyroxine formation is inhibited due to high levels of circulating iodide
14
Q
Safest anti-epileptics in pregnancy?
A
Carbamazepine and lamotrigine
15
Q
HTN in pregnancy?
A
Labetalol
16
Q
HTN in asthmatic pregnancy?
A
Nifedipine
17
Q
Chloramphenicol in pregnancy?
A
Grey baby syndrome
18
Q
Lithium in pregnancy?
A
Ebstein’s anomaly
19
Q
Tetracyclines in pregnancy?
A
Discoloured teeth
20
Q
Warfarin in pregnancy?
A
Craniofacial abnormalities
21
Q
Digoxin MOA?
A
- Decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
- Increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump.
- Also stimulates vagus nerve
22
Q
Mx of digoxin toxicity?
A
- Digibind
2. Correct arrhythmias, monitor potassium
23
Q
St Johns Wort inducer/inhibitor?
A
Inducer
24
Q
4 causes of serotonin syndrome?
A
- SSRIs
- MAO-inhibitors
- Ecstasy
- Amphetamines
25
3 features of serotonin syndrome?
1. Neuromuscular excitation = hyperreflexia, myoclonus, rigidity
2. ANS excitation = hyperthermia
3. Altered mental state
26
Mx of serotonin syndrome?
1. IV fluids
2. Benzodiazepines
3. Severe --> serotonin antagonists e.g. chlorpromazine
27
Heparin MOA?
Activating antithrombin III
28
Unfractionated heparin MOA?
Forms a complex which inhibits thrombin, factors 9,10,11,12
29
LMWH MOA?
Increases action of antithrombin III on factor Xa
30
4 s/es of heparins?
1. Bleeding
2. Thrombocytopenia
3. Osteoporosis
4. Hyperkalaemia (inhibition of aldosterone secretion)
31
Heparin monitoring?
APTT
32
LMWH monitoring?
Anti-Factor Xa
33
Heparin OD Mx?
Protamine sulphate
34
Mefloquine c/i?
Hx of anxiety or depression
35
Ciclosporin s/e?
Everything is increased
1. HTN
2. K+
3. Hair
4. Gums
5. Glucose
6. Tremor
36
4 indications of ciclosporin?
1. Organ transplantation
2. RhA
3. Psoriasis
4. UC
37
3 s/es of amlodipine?
1. Headache
2. Flushing
3. Ankle oedema
38
Verapamil MOA?
Negatively inotropic
39
Diltiazem MOA?
Negatively inotropic
40
Nifedipine/amlodipine MOA?
Peripheral vascular smooth muscle relaxation
41
2 s/es of metformin?
1. Lactic acidosis
| 2. GI s/e
42
Gliptins s/e?
Pancreatitis
43
Glitazones 4 s/es?
1. Weight gain
2. Fluid retention
3. Liver dysfunction
4. Fractures
44
Sulfonylureas s/es?
1. Hypos
2. Weight gain and increased appetite
3. SIADH
4. Cholestatic liver dysfunction
45
Why does alcohol lead to polyuria?
Inhibits ADH secretion by blocking calcium channels in the neurohypophyseal nerve terminal
46
Nausea in hangovers?
Vagal stimulation of the vomiting centre
47
Tremors after alcohol?
Increased glutamate production by neurones to compensate for the previous inhibition by ethanol
48
3 drugs used for alcohol addiction?
1. BZDs for acute withdrawal
2. Disulfiram = inhibition of acetaldehyde dehydrogenase
3. Acamprosate = NMDA receptor agonist, reduces craving
49
3 s/e of rifampicin?
1. Orange secretions
2. Hepatitis
3. Flu-like symptoms
50
Isoniazid MOA?
Inhibits mycolic acid synthesis
51
3 s/e of isoniazid?
1. Peripheral neuropathy
2. Hepatitis
3. Agranulocytosis
52
Isoniazid inhibitor or inducer?
Inhibitor
53
Pyrazinamide MOA?
Converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I
54
S/e of pyrazinamide?
1. Hepatitis
2. Arthralgia
3. Myalgia
4. Hyperuricaemia causing gout
55
Ethambutol MOA?
Inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan
56
S/e of ethambutol?
Optic neuritis
57
Notable verapamil s/e?
Constipation
58
BB 4 s/e?
1. Bronchospasm
2. Fatigue
3. Cold peripheries
4. Sleep disturbance
59
Nitrates 3 s/es?
1. Headache
2. Tachycardia
3. Postural hypotension
60
Nicorandil 3 s/es?
1. Headache
2. Flushing
3. Anal ulceration
61
Sildafenil MOA?
PDE-V inhibitor, cause vasodilation through increase in cGMP leading to smooth muscle relaxation in blood vessels supplying the corpus cavernosum
62
3 PDE-V inhibitors?
1. Sildafenil = Viagra
2. Tadalafil = Cialis
3. Vardenafil = Levitra
63
C/Is to PDE-V inhibitors?
1. Nitrates
2. Hypotension
3. Recent stroke/MI
64
Viagra notable s/e?
Blue pill causes blue discoloration of vision
65
PDE-V s/es?
1. Visual disturbances
2. Nasal congestion
3. Flushing
4. Headache
5. GI s/e
66
Which Abx can lower seizure threshold?
Quinolones e.g. ciprofloxacin
67
Quinolones MOA?
Inhibit Topoisomerase II (DNA gyrase) and Topoisomerase IV --> inhibit DNA synthesis --> bactericidal
68
Quinolone resistance MOA?
Mutations to DNA gyrase and efflux pumps which reduce intracellular quinolone concentration
69
Quinolones s/e?
1. Lower seizure threshold
2. Tendon damage
3. Cartilage damage
4. QT prolongation
70
Quinolone c/i?
1. Pregnancy/breastfeeding
| 2. G6PDD
71
Initial pain management of acute pancreatitis?
IV morphine in 1-2mg boluses until comfortable
72
Salicylate poisoning mx?
Haemodialysis
73
Opioid OD mx?
Naloxone
74
BZD OD mx?
Flumazenil
75
TCA OD Mx?
1. IV bicarbonate may reduce risk of seizures and arrhythmias
76
Lithium OD Mx?
1. Normal saline
2. Haemodialysis
3. Sodium bicarbonate
77
Warfarin OD Mx?
1. Vit K
| 2. Prothrombin complex
78
Heparin OD Mx?
Protamine sulphate
79
BB OD Mx?
1. If bradycardic then atropine
| 2. In resistant cases glucagon may be used
80
Ethylene glycol poisoning Mx?
1. Fomepizole = inhibitor of alcohol dehydrogenase
2. Ethanol
3. Haemodialysis
81
Methanol poisoning Mx?
1. Fomepizole or ethanol
| 2. Haemodialysis
82
Organophosphate poisoning Mx?
Atropine
83
Digoxin OD Mx?
Digoxin-specific Ab fragments
84
Iron OD Mx?
Desferrioxamine
85
Lead OD Mx?
1. Demercaprol
| 2. Calcium edetate
86
CO OD Mx?
1. 100% oxygen
| 2. Hyperbaric oxygen
87
Cyanide OD Mx?
1. Hydroxycobalamin
| 2. Combination of amyl nitrite, sodium nitrite and sodium thiosulphate
88
4 s/e of finasteride?
1. Impotence
2. Decreased libido
3. Ejaculation disorders
4. Gynaecomastia and breast tenderness
89
Finasteride MOA?
5a reductase inhibitor
90
Finasteride effect on PSA?
Decreases PSA
91
Metformin MOA?
Biguanide that activates AMP-activated protein kinase (AMPK) --> increases insulin sensitivity and decreases hepatic gluconeogenesis
92
C/I to metformin?
1. CKD
2. Recent MI
3. Severe dehydration
93
Drug metabolism Phase I and Phase II reactions?
1, Phase I reactions = oxidation, reduction, hydrolysis. Mainly performed by the P450 enzymes but some drugs are metabolised by specific enzymes, for example alcohol dehydrogenase and xanthine oxidase. Products of phase I reactions are typically more active and potentially toxic
2. Phase II reactions = conjugation. Products are typically inactive and excreted in urine or bile. Glucuronyl, acetyl, methyl, sulphate and other groups are typically involved
94
Where do the majority of Phase I and II reactions take place?
The liver
95
What is zero order kinetics?
Metabolism which is independent of the concentration of the reactant, due to metabolic pathways becoming saturated resulting in a constant amount of drug being eliminated per unit time
96
4 drugs exhibiting zero order kinetics?
1. Phenytoin
2. Aspirin
3. Heparin
4. Ethanol
97
What % of the UK population are deficient in hepatic N-acetyltransferase?
50%
98
Heparin-induced thrombocytopenia (HIT) is prothrombotic or not?
Is prothrombotic
99
Why should metformin be stopped following an MI?
Due to a risk of lactic acidosis
100
6 features of opioid abuse?
1. Pinpoint pupils
2. Watering eyes
3. Rhinorrhoea
4. Drowsiness
5. Yawniing
6. Needle track marks
101
First line txs for opioid dependence?
Methadone or buprenorphine
102
4 drugs to avoid in CKD?
1. Abx = tetracycline, nitrofurantoin
2. NSAIDs
3. Lithium
4. Metformin
103
5 drugs causing lung fibrosis?
1. Amiodarone
2. Methotrexate
3. Cytotoxics e.g. bleomycin
4. Nitrofurantoin
5. DA agonists = bromocriptine, cabergoline
104
2 main indications of alpha blockers?
1. BPH e.g. tamsulosin
| 2. HTN e.g. doxazosin
105
3 precipitators of lithium toxicity?
1. Dehydration
2. Renal failure
3. Drugs = thiazides, ACEi/ARBs, NSAIDs, metronidazole
106
What should be done before using flecainide in AF?
Echo to look for structural heart disease
107
Flecainide?
1. Slows conduction of AP by acting as a sodium channel blocker
108
2 indications for flecainide?
1. AF
| 2. WPW
109
C/I to flecainide?
1. Post-MI
2. Structural heart disease
3. Atrial flutter
5. Sinus node dysfunction
110
Who is responsible for collating and assessing the Yellow Card reports?
Medicines and Healthcare products Regulatory Agency (MHRA)
111
Characteristic amoxicillin s/e?
Rash with infectious mononucleosis
112
Characteristic co-amoxiclav s/e?
Cholestasis
113
Characteristic flucloxacillin s/e?
Chloestasis
114
Characteristic Erythromycin s/e?
1. GI upset
| 2. Prolongs QT interval
115
Characteristic ciprofloxacin s/e?
1. Lowers seizure threshold
| 2. Tendonitis
116
Characteristic metronidazole s/e?
Reaction following alcohol ingestion
117
Characteristic doxycycline s/e?
Photosensitivity
118
Characteristic trimethoprim s/e?
1. Rashes incl. photosensitivity
2. Pruritis
3. Suppression of haematopoiesis
119
Amiodarone s/e?
1. Neuro = peripheral neuropathy
2. Eyes = corneal deposits
3. Thyroid
4. Heart = bradycardia, QT prolongation
5. Lungs = fibrosis
6. Liver = cirrhosis
7. Skin = slate grey, thrombophlebitis, photosensitivity
120
Digoxin toxicity fx>
1, Generally unwell
2. Arrhythmias
3. Gynaecomastia
121
4 Urinary retention drugs?
1. Anticholinergics
2. TCA
3. Opioids
4. NSAIDs
122
Ecstasy aka?
MDMA, 3,4-Methylenedioxymethamphetamine
123
Ecstasy poisoning features?
1. Neuro = agitation, anxiety, confusion, ataxia
2. CVS = tachycardia, HTN
3. Hyponatraemia
4. Hyperthermia
5. Rhabdomyolysis
124
Doxazosin MOA?
Alpha 1 blocker
125
Each 200mg tablet of amiodarone releases how much free iodine?
6mg
126
Alpha 1 agonist?
Decongestants e.g. phenylephrine
127
Alpha 2 agonist?
Glaucoma e.g. topical brimonidine
128
Alpha antagonists?
1. BPH e.g. tamsulosin
| 2. HTN e.g. doxazosin
129
B1 agonist?
Inotrope e.g. dobutamine
130
B1 antagonist?
1. Non-selective = atenolol
| 2. Selective = bisoprolol
131
B2 agonist?
Bronchodilators e.g. salbutamol
132
B2 antagonists?
Propranolol, labetalol
133
DA Agonist?
1. Parkinsons disease e.g. Ropinorole
| 2. Prolactinoma
134
DA Antagonist?
1. Antipsychotics
| 2. Antiemetics e.g. metoclopramide/domperidone
135
GABA agonist?
Benzodiazepines, Baclofen
136
GABA antagonist?
Flumazenil
137
H1 antagonist?
Antihistamine e.g. loratidine
138
H2 antagonist?
Antacids e.g. ranitidine
139
Muscarinic agonist?
Glaucoma e.g. pilocarpine
140
Muscarinic antagonists?
1. Atropine for bradycardia
2. Ipratropium for bronchodilation
3. Oxybutinin for urge incontinence
141
Nicotinic receptor agonist?
1. Nicotine
2. Varenicline (smoking cessation)
3. Depolarising muscle relaxant e.g. suxamethonium
142
Nicotinic receptor antagonists?
Non-depolarising muscle relaxants e.g. atracurium
143
Oxytocin receptor agonist?
Inducing labour e.g. syntocinon
144
Oxytocin receptor antagonists?
Tocolysis e.g. atosiban
145
Serotonin receptor agonist?
Triptans e.g. zolmatriptan
146
Serotonin receptor antagonist
Anti-emetics e.g. ondansetron
147
Motion sickness Mx?
Hyoscine > cyclizine > promethazine
148
When should allopurinol be started?
2 weeks after an acute attack has settled
149
Skin complications of allopurinol?
1. Severe cutaneous adverse reaction (SCAR)
2. Drug reaction with eosinophilia and systemic symptoms (DRESS)
3. SJS
150
3 interactions of allopurinol?
1. Azathioprine
2. Cyclophosphamide
3. Theophylline
151
Yellow tinting of vision?
Digoxin
152
Ondansetron MOA?
5-HT3 antagonist
153
5-HT1 agonist?
Sumatriptan
154
5-HT2 antagonist?
Pizotifen
155
5-HT3 antagonist?
Ondansetron
156
Diabetes drug that causes pancreatitis?
Gliptins
157
Gentamicin MOA?
Aminoglycoside
158
S/e of gentamicin?
1. Ototoxicity = irreversible, due to auditory or vestibular nerve damage
2. Nephrotoxicity = accumulates in renal failure, lower doses and more frequent monitoring required
159
C/I of gentamicin?
Myasthenia gravis
160
Gentamicin dosing?
1. Both peak (1 hour after administration) and trough levels (just before the next dose) are measured
2. If the trough (pre-dose) level is high the interval between the doses should be increased
3. If the peak (post-dose) level is high the dose should be decreased
161
BNF CD meaning?
Controlled drug
162
BNF PoM meaning?
Prescription only medicine
163
BNF NHS with cross meaning?
Not prescribable on NHS
164
BNF black triangle meaning?
Newly licensed medication
165
BNF black and white box meaning?
A preparation that is less suitable to prescribe
166
When should lithium level be monitored?
12 hours post dose
167
When should ciclosporin levels be measured?
Trough levels immediately before dose
168
When should digoxin levels be measured?
At least 6 hours post dose
169
Rifampicin P450?
Inducer
170
Isoniazid P450?
Inhibitor
171
Smoking P450?
Inducer (affects CYP1A2, which smokers require more aminophylline)
172
Cocaine MOA?
Blocks uptake of DA, NA and HT
173
S/e of cocaine>
1. CVS = MI, tachy, HTN, QRS widening, QT prolongation, disssection
2. Neuro = seizures, hypertonia, hyperreflexia, mydriasis
3. Psych = agitation, psychosis, hallucinations
174
Abdo pain/rectal bleeding after cocaine?
Ischaemic colitis
175
Cocaine toxicity mx?
Benzodiazepines
1. CP = + GTN
2. HTN = + sodium nitroprusside
176
Phenytoin monitoring time?
Immediately before next dose (trough levels)
177
St Johns Wort P450?
Inducer
178
Transaminases in the 10,000s?
Paracetamol OD
179
Severe renal impairment heparin choice?
UFH
180
Most highly negatively inotropic calcium channel blocker?
Verapamil
181
Breakthrough analgesia dose?
1/6th of the total daily opioid dose
182
Salicylate OD blood gas?
Mixed respiratory alkalosis and metabolic acidosis
183
Salicylate overdose fx?
1. Hyperventilation
2. Tinnitus
3. Seizures
184
Mx of aspirin OD?
1. ABC, charcoal
2. Urinary alkisation with IV sodium bicarb
3. Haemodialysis
185
Drugs causing photosensitivity?
1. Amiodarone
2. Tetracyclines, sulphonamides, ciprofloxacin
3. Thiazides
4. NSAIDs
5. Psoralens
6. Sulphonylureas
186
Carboxyhaemoglobin levels in smokers?
Up to 10%
187
Contrast CT, how long should metformin be stopped for?
48 hours after the scan due to risk of renal impairment
188
Fx of organophosphate poisoning?
SLUD CO
1. Salivation
2. Lacrimation
3. Urination
4. Diarrhoea
5. CVS = hypotension, bradycardia
6. Other = small pupils, muscle fasciculation
189
Can digoxin toxicity occur even if conc is within the therapeutic range>
Yes
190
Classic precipitating factor of digoxin toxicity?
Hypokalaemia
191
Metformin eGFR C/i?
If eGFR < 30
192
Methotrexate monitoring bloods?
FBC, TFT, U&E
193
Levetiracetam monitoring?
Not needed
194
Amiodarone monitoring?
1. TFT, LFT, U&E, CXR prior to tx
| 2. TFT, LFT every 6m
195
Statin monitoring?
LFT at baseline, 3m 12m
196
ACEi mointoring?
U&E prior to tx, after increasing dose, and at least anually
197
Azathioprine monitoring?
FBC, LFT
198
Lithium monitoring?
1. TFT, U&E prior to treatment
2. Lithium levels weekly until stabilised then every 3 months
3. TFT, U&E every 6 months
199
Sodium valproate monitoring?
1. LFT, FBC before treatment
| 2. LFT 'periodically' during first 6 months
200
Glitazone monitoring?
LFT before and regularly during treatment
201
S/e of tamoxifen?
1. Menstrual disturbance
2. Hot flushes
3. VTE
4. Endometrial cancer
5. Osteoporosis
202
How long after removal of tumour is tamoxifen usually used for?
5 years
203
UFH monitoring?
APTT
204
Cocaine on ABG?
Metabolic acidosis
205
Mechanism of aspirin ABG findings?
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.
206
Chronic alcoholism magnesium?
Hypomagnesaemia
207
Hypomagnaesaemia associations?
1. Hypokalaemia
2. Hypocalcaemia
3. Hypophosphataemia
4. Metabolic acidosis
208
Causes of low magnesium?
1. Drugs = Diuretics, PPIs
2. TPN
3. Diarrhoea
4. Alcohol
5. Hypokalaemia, hypocalcaemia
209
Mx of low magnesium?
1. <0.4mmol/l = IV magnesium sulphate 40mmol over 24 hours
| 2. >0.4mmol/l = oral magnesium salts 10-20mmol per day
210
Adrenaline doses for anaphylaxis and cardiac arrest?
1. Anaphylaxis = 0.5ml 1:1,000 IM
| 2. Cardiac arrest = 1ml 1:1000 IV
211
Most common s/e of sildafenil?
1. Visual disturbances
2. Nasal congestions
3. Flushing
4. GI side effects
5. Headache
212
2 indications of finasteride?
1. BPH
| 2. Male pattern baldness
213
4 s/e of finasteride?
1. Impotence
2. Decreased libido
3. Ejaculation disorders
4. Gynaecomastia and breast tenderness
214
Mx of accidental injection of adrenaline?
Local infiltration of phentolamine
215
Lithium excretion?
Renal
216
3 drugs that aspirin potentiates?
1. Oral hypoglycaemics
2. Warfarin
3. Steroids
217
Confusion, pink mucosae and low grade pyrexia?
CO poisoning
218
Metformin not tolerated due to GI s/e?
Try a modified release formation
219
Drug causing cataracts?
Steroids
220
Drugs causing corneal opacities?
1. Amiodarone
| 2. Indomethacin
221
3 drugs causing optic neuritis?
1. Ethambutol
2. Amiodarone
3. Metronidazole
222
3 causes of oculogyric crisis?
1. Antipsychotics
2. Metoclopramide
3. Postencephalitic Parkinson's disease
223
Mx of oculogyric crisis?
IV antimuscarinic e.g. benztropine or procyclidine
224
Amiodarone interaction
1. Decreased metabolism of warfarin
| 2. Increased digoxin levels
225
Theophylline OD Mx?
1. Haemodialysis
| 2. Activated charcoal regardless of the time of presentation
226
Caution when using cyclizine?
In pts with HF as it may cause a fall in cardiac output
227
Cyclizine MOA?
H1-receptor antagonist that acts by blocking histamine receptors in the CTZ
228
Carbamazepine P450?
Carbamazepine is an inducer of the P450 system. This in turn increases the metabolism of carbamazepine itself - auto-induction
229
4 indications of Spironolactone?
1. Ascites
2. HF
3. Nephrotic syndrome
4. Conn's
