passmed randoms Flashcards
signs that you will see in serotonin syndrome
lower limb hyperreflexia, ankle clonus, increased tone and a fine tremor in the upper limbs
digoxin and sidenafil have vision changes due to the drug side effects what are they
Visual changes secondary to drugs
blue vision: Viagra (‘the blue pill’)
yellow-green vision: digoxin
sidenafil moa
Phosphodiesterase type V (PDE5) inhibitors
short-acting - usually taken 1 hour before sexual activity
contraindications to taking sidenafil
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
indications for liver transplant in paracetamol overdose
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
pulmonary oedema and metabolic acidosis in aspriin overdose require what tx not - IV bicarb in this situation
haemolysis
flecanide what class of drug
sodium channel blocker (specifically the Nav1.5 sodium channels).
contraindications to flecanide
post myocardial infarction
structural heart disease: e.g. heart failure
sinus node dysfunction; second-degree or greater AV block
atrial flutter
inhibtors of p450
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
inducers of p450
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
features of ecstasy
neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA
hyperthermia
rhabdomyolysis
what is nicorandil
anti-anginal drug which has dual properties of a nitrate and a potassium channel agonist. Since nitrate use is an absolute contraindication for prescribing sildenafil, nicorandil is the correct answer here.
smokers carboxyhaemaglobin levels
Smokers may normally have carboxyhaemoglobin levels of up to 10%
what is HIT - heparn induced thrombocytopenia
The correct answer is HIT is a prothrombotic condition. Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin therapy. It leads to the formation of antibodies against complexes of platelet factor 4 and heparin, which can activate platelets and cause thrombosis, hence it is a prothrombotic condition.
A 61-year-old man, who takes warfarin, comes to the GP for a blood test to measure his international normalised ratio (INR). He has a past medical history of atrial fibrillation and epilepsy. His target INR range is between 2 and 3. However, the blood test reveals an INR of 4. On questioning, he informs you that he was recently started on a new medication.
Which of these medications is most likely responsible for the change in INR?
Sodium valproate is an enzyme INhibitor so can INcrease warfarin levels if used concurrently
Since cardiac bypass circuits are thrombogenic large doses of intravenous heparin are administered. This is reversed with
protamine sulphate. FFP may be effective but would carry a significant risk of fluid overload.
triptans moa
serotonin agonsits
drugs mechansim for BPH
alpha antagonist
What drug will you administer to reduce the risk of isoniazid induced peripheral neuropathy?
Pridoxine (vitamin B6) should be co-administered with isoniazid to prevent peripheral neuropathy
You are considering a diagnosis of Crohn’s disease in a 14-year-old boy who presents with gastrointestinal symptoms. Which one of the following is the most common symptom of Crohn’s disease in children?
abdo pain
Organophosphate poisoning is characterised by the acronym ‘DUMBBELLS’ which stands for
Defecation, Urination, Miosis, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Lethargy and Salivation
mechanism is not delineated but it is thought to inhibit central cholinergic receptors, and thus balance cholinergic and dopaminergic activity in the basal ganglia - oculgyric crisis - what are some of the features and how is it treated
agitated and restless
sustained upward deviation of the eyes
back pain - spinal mets treat with what
bisphosponares and radiotherapy
most effevtive pain relief in children
paracetamol
inducers do what to ciclosporin
decrease ciclosporin levels and lead to transplant rejection
Anaphylactoid reactions to IV N-Acetylcysteine are generally treated
stopping the infusion, then restarting at a slower rate
moa aspirin
Inhibits the production of thromboxane A2
Patients with MI secondary to cocaine use should be given IV
benzodiazepines as part of acute (ACS) treatment
Amiodarone may cause precipitation of what drug
digoxin - as inhibtor of p450
Azathioprine is a prodrug, meaning it is metabolised to its active form, 6-mercaptopurine, which causes immunosuppression (preventing kidney rejection in this patient). The active 6-mercaptopurine is subsequently metabolised by xanthine oxidase to inactive this uric acid which is excreted. As allopurinol inhibits xanthine oxidase, the combination of the two drugs can lead to excessive myelosuppression and therefore increase the risk of
neutropenic sepsis
low mg cause drug common
ppi
aboid what abx in renal failure or disease
tetracycline, nitrofurantoin
