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1
Q

PDE5 inhibitors (e.g. sildenafil) are contraindicated by which 2 medications

A

Nitrates and nicorandil

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2
Q

PDE5 inhibitors (e.g. sildenafil) are used in treatment of erectile dysfunction and…

A

pulmonary hypertension

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3
Q

3 contraindications to PDE5 inhibitors (e.g. sildenafil - Viagra)

A
  1. Meds - nitrates or nicorandil
  2. Hypotension
  3. MI/stroke in last 6 months
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4
Q

Viagra (sildenafil) causes what side effects

A

Visual disturbances
- blue discolouration ‘the blue pill’
- Anterior ischaemic neuropathy
Nasal congestion
Flushing
GI side effects
Priapism
Headache

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5
Q

What drug causes blue vision

A

Viagra (sildenafil)

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6
Q

What drug causes green/yellow vision in toxicity

A

Digoxin

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7
Q

Digoxin level is only monitored in suspected toxicity. When should they be measured?

A

Within 8-12 hours of last dose

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8
Q

Digoxin mechanism of action - 3 main points (conduction, muscle contraction, nerves)

A
  • Decreases AV node conduction to slow ventricular rate (in AF and flutter)
  • Increases cardiac muscle contraction due to inhibition of Na/K ATPase pump
  • Stimulates vagus nerve
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9
Q

Features of digoxin toxicity

A

Nausea + vomiting
Confusion
Yellow-green vision
Gynaecomastia
Arrhythmias

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10
Q

What is an endocrine change with digoxin toxicity

A

Gynaecomastia

+ anorexi

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11
Q

What is an electrolyte disturbance that triggers digoxin toxicity

A

Hypokalaemia

Leads to more binding of digoxin to ATPase pump and increases the effects

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12
Q

Management of digoxin toxicity - 3 steps

A
  1. Digibind
  2. Correct arrhythmias
  3. Monitor potassium
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13
Q

What is the most common side effect of finasteride (5-alpha reductase inhibitor)

A

Gynaecomastia

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14
Q

Finasteride is a 5-alpha reductase inhibitor

What is its mechanism of action

A

Reduces the conversion of testosterone to dihydrotestosterone (DHT)

DHT is more potent so inhibiting it helps to reduce prostate size

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15
Q

2 indications of finasteride

A
  1. BPH
  2. Male pattern baldness
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16
Q

Finasteride effects on PSA level

A

Reduces serum PSA

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17
Q

When and what bloods should be monitored for ACE inhibitors

A

U+E before starting or increasing dose
U+E at least annually

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18
Q

When and what bloods should be monitored for amiodarone

A

TFTs, LFTs, U+Es, CXR before starting
TFTs, LFTs every 6 months

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19
Q

When and what bloods should be monitored for methotrexate

A

FBC, LFTs, U+Es before starting
Repeat weekly until stable
Then every 2-3 months

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20
Q

When and what bloods should be monitored for azathioprine

A

FBC, LFT before starting
FBC weekly for first 4 weeks
FBC, LFTs every 3 months

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21
Q

When and what bloods should be monitored for lithium

A

TFTs, U+Es before starting
TFTs, U+Es every 6 months

Lithium levels weekly until stable
Then every 3 months

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22
Q

When and what bloods should be monitored for sodium valproate

A

LFTs, FBC before starting
LFTs periodically during first 6 months

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23
Q

When and what bloods should be monitored for glitazones

A

LFTs before starting
LFTs regularly during treatment

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24
Q

what anticoagulant is okay for use in CKD4

A

warfarin

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25
Q

for iodine-containing x-ray contrast media e.g. angiography, when should metformin be held to avoid contrast renal impairment

A

hold metformin on day of procedure and for 48 hours afterwards

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26
Q

mechanism of action of metformin

A
  • activates AMPK
  • increases insulin sensitivity
  • decreases hepatic gluconeogenesis
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27
Q

when should ciclosporin levels be taken

A

trough levels
IMMEDIATELY BEFORE dose

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28
Q

lithium levels when should they be monitored

A

12 hours post-dose

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29
Q

phenytoin levels - trough when should dose be checked

A

IMMEDIATELY BEFORE dose

(if adjusting dose, or suspected toxicity)

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30
Q

Lithium toxicity may be triggered by what 3 things

A
  1. Dehydration
  2. Renal failure
  3. Drugs - diuretics, ACEi/ARBs, NSAIDs and metronidazole
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31
Q

Lithium toxicity signs

A

Coarse tremor
Hyperreflexia
Confusion
Seziures
++ urine

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32
Q

Management of lithium toxicity

A
  • Fluids
  • Haemodialysis in severe toxicity
  • Sodium bicarb sometimes to promote lithium excretion
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33
Q

What is the most appropriate dose of adrenaline to give during a cardiac arrest?

A

10ml (1mg) 1:10000 IV
or 1ml 1:1000 IV

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34
Q

which diabetic medication can sometimes lead to low B12

A

metformin

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35
Q

Emergency management of opioid overdose

A

IV or IM naloxone

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36
Q

First line treatments in opioid detoxification

A

Methadone
Buprenorphine

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37
Q

compliance for opioid detox medication (e.g. methadone or buprenorphine) is monitored using..

A

urinalysis

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38
Q

how long does opioid detox usually last up to in:
(a) inpatient setting
(b) community

A

(a) inpatient setting - 4 weeks
(b) community - 12 weeks

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39
Q

methadone mechanism of action

A

mu-opioid receptor agonist

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40
Q

buprenorphine mechanism of action

A

mu-opioid receptor partial agonist
kappa-opioid antagonist

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41
Q

Carbon monoxide toxicity leads to which skin/mucosa changes

A

Pink skin and mucosa

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42
Q

Typical carboxyhaemoglobin % levels in:
(a) non-smokers
(b) smokers
(c) symptomatic
(d) severe toxicity

A

(a) non-smokers <3%
(b) smokers <10%
(c) symptomatic 10-30%
(d) severe toxicity >30%

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43
Q

Management of carbon monoxide poisoning

A

100% high flow O2 non-rebreather
Continue Rx for 6 hours minimum
Target sats 100%
Continue treatment until all symptoms resolved

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44
Q

St john’s wort effect on P450 system

A

P450 inducer

Reduces effect of COCP and warfarin etc

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45
Q

On average, what percentage of patients will eventually take antibiotics if delayed Abx strategy is employed?

A

33%

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46
Q

MDMA poisoning leads to what electrolyte disturbance

A

HYPOnatraemia

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47
Q

Management of MDMA poisoning

A

Supportive
Dantrolene for hyperthermia

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48
Q

NICE recommend that the dose of metformin should be reviewed and stopped if levels are above:
(a) creatinine
(b) eGFR

A

(a) Cr >130 - review, >150 - stop
(b) eGFR <45 - review, <30 - stop

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49
Q

Metformin should be titrated slowly, how long should be left between dose changes

A

Leave at least 1 week before increasing dose

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50
Q

4 drug groups that commonly cause urticaria

A

Aspirin
Penicillin
NSAIDs
Opiates

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51
Q

What drugs can lead to lithium toxicity

A

diuretics
ACEi/ARBs
NSAIDs
metronidazole

therefore HTN patients should be on CCB if possible

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52
Q

what antibiotics interact with statins

A

MACROLIDES
i.e. erythro/clari

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53
Q

Alcoholic patients should receive what supplementation

A

THIAMINE ONLY

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54
Q

Drugs used for management of alcohol misuse for detox

A
  • Benzodiazepines for acute withdrawal
  • Disulfram: promotes abstinence, causes reaction. Contraindicated in IHD and psychosis
  • Acamprosat: reduces craving, weak antagonist of NMDA receptors
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55
Q

If woman is >55 or no periods for >1 year then which HRT is chosen:
continuous or cyclical

A

continuous

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56
Q

side effects of alpha-blockers

A

postural hypotension
drowsiness
cough
SOB

57
Q

risk of cataract surgery with a-blockers

A

intra-operative floppy iris syndrome

58
Q

alpha blockers what are the 2 main indications for use

A

benign prostatic hyperplasia
hypertension

59
Q

women on statins wanting to try for a baby - what is the advice

A

stop 3 months before conception

due to risk of congenital defects

60
Q

At what point do patients have a repeat cholesterol test done to test the effectiveness of the statin?

A

At 12 weeks (3 months)
Aims to reduce non-HDL by >40%

Lipid profile and liver function tests are done

61
Q

Lipid profile and liver function tests are rechecked after 3 months (12 weeks) from starting a statin.

What is the aim for the cholesterol?

A

> 40% reduction in non-HDL levels

62
Q

Familial Hypercholesterolaemia - What is the inheritance trait

A

autosomal dominant

63
Q

hyperuricaemia (high levels of uric acid) may be seen in many patients such as in hyperlipidaemia or hypertension.

if they are asymptomatic without gout, what is done about urate lowering treatment?

A

No prophylactic treatment needed if asymptomatic

64
Q

what does vitamin A (retinoid) deficiency cause

A

night blindness (nyctalopia)

65
Q

what does vitamin B1 (thiamine) deficiency cause

A

Beri-beri syndrome: polyneuropathy, Wernicke’s

Heart failure

66
Q

what does vitamin B3 (niacin) deficiency cause

A

Pellagra
- dermatitis, diarrhoea, dementia

67
Q

what does vitamin B6 (pyridoxine) deficiency cause

A

anaemia
irritability
seizures

68
Q

what does vitamin B7 (biotin) deficiency cause

A

dermatitis
seborrhoea

69
Q

what does vitamin B9 (folic acid) deficiency cause

A

megaloblastic anaemia
neural tube defects

70
Q

what does vitamin C (ascorbic acid) deficiency cause

A

scurvy
- gingivitis
- bleeding

71
Q

what does vitamin D (ergo/cholecalciferol) deficiency cause

A

rickets
osteomalacia

72
Q

what does vitamin E (tocopherol) deficiency cause

A

mild haemolytic anaemia in newborn infants
ataxia
peripheral neuropathy

73
Q

what does vitamin K (napthoquinone) deficiency cause

A

haemorrhagic disease of newborn
bleeding

74
Q

causes of hypovolemic hyponatraemia (i.e. clinically dehydration)

A

diuretics
renal failure
Addison’s crisis

75
Q

cause of euvolaemic hyponatraemia

76
Q

causes of hypervolaemic hyponatraemia

A

heart failure
liver failure
nephrotic syndrome

77
Q

treatment of euvolaemic hyponatraemia (SIADH)

A
  • fluid restrict
  • meds: demeclocycline, vaptans
78
Q

treatment of hypervolaemic hyponatraemia (i.e. heart failure, liver failure, nephrotic syndrome)

A
  • fluid restrict
  • meds: loop diuretics, vaptans
79
Q

Vasopressin/ADH receptor antagonists (vaptans) mechanism of action

A

V2 receptor antagonists
Selective water diuresis
Spares electrolytes

80
Q

Overcorrection of hyponatraemia too quickly can cause osmotic demyelination syndrome. therefore to avoid this, sodium levels are only raised by how much per day

A

4-6 mmol/l over 24 hours

81
Q

what BMI is classed as underweight

82
Q

What is a normal BMI

83
Q

What are the BMI ranges for:
- overweight
- obese
- clinically obese
- morbidly obese

A
  • overweight 25-30
  • obese 30-35
  • clinically obese 35-40
  • morbidly obese >40
84
Q

Patients with acute severe hyponatraemia should be urgently admitted to hospital when their serum sodium concentration is less than what

A

Less than 125mmol/L

85
Q

common malignant cause of SIADH

A

small cell lung cancer

86
Q

what drugs can cause SIADH

A

sulfonylureas
SSRIs
carbamazepine
tricyclic antidepressants

87
Q

urine osmolality and sodium concentration in SIADH

A

Urine osm - inappropriately high
Urine sodium conc - high

88
Q

management of SIADH

A
  • fluid restiction
  • demeclocyclin
  • ADH (vasopressin) receptor antagonists
89
Q

What is NICE advice with regards to physical activity?

A

Each week at least 150mins of moderate intensity aerobic activity or 75mins of vigorous intensity aerobic activity

90
Q

4 causes of Hypokalaemia with hypertension

A
  1. Cushing’s syndrome
  2. Conn’s syndrome
  3. Liddle’s syndrome
  4. 11-b hydroxylase deficiency
91
Q

4 causes of Hypokalaemia without hypertension

A
  1. diuretics
  2. GI loss
  3. renal tubular acidosis
  4. bartter’s syndrome
  5. gitelman syndrome
92
Q

Consider the possibility of familial hypercholesterolaemia and investigate as described in familial hypercholesterolaemia if the patient has one of which two criteria?

A
  1. Total cholesterol >7.5
  2. Family history of premature coronary heart disease
93
Q

rifampicin side effects

A

hepatitis
orange secretions
liver enzyme INDUCER

94
Q

isoniazid side effects (TB drug)

A

hepatitis
agranulocytosis
peripheral neuropathy - prevent with pyridoxine, vitamin B6
liver enzyme INHIBITOR

95
Q

pyrazinamide side effects

A

hyperuricaemia - causing gout
arthralgia
hepatitis

96
Q

ethambutol side effects

A

optic neuritis
- check visual acuity before and during treatment

97
Q

Bendroflumethiazide side effects

A

Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance

98
Q

b-blockers side effects

A

bronchospasm
fatigue
cold peripheries

99
Q

Who is responsible for collating and assessing the Yellow Card reports?

A

Medicines and Healthcare products Regulatory Agency (MHRA)

100
Q

fast onset
sweating
tremor
confusion
hyper-reflexia

what is the diagnosis:
serotonin syndrome or neuroleptic malignant syndrome

A

serotonin syndrome

101
Q

What is the treatment of serotonin syndrome and neuroleptic malignant syndrome

A

IV fluids
Benzodiazepines

Dantrolene - for severe NMS

102
Q

What is the difference in reflexes and onset between serotonin syndrome and neuroleptic malignant syndrome?

A

Serotonin syndrome - hyperreflexia, fast onset

Neuroleptic malignant syndrome - hyporeflexia, slow onset

103
Q

what two side effects is azithromycin associated with

A

tinnitus
hearing loss

104
Q

erythromycin and clarithromycin do what to liver enzymes

A

P450 inhibitor

105
Q

adverse effects of amiodarone

A

thyroid - hyper/hypo
corneal deposits
pulmonary fibrosis
liver fibrosis
peripheral neuropathy
photosensitivity
prolonged QT interval
bradycardia

106
Q

2 important drug interactions of amiodarone include

A
  1. decreased warfarin metabolism therefore high INR
  2. increased digoxin levels
107
Q

St Johns wort and SSRIs can lead to …

A

serotonin syndrome

108
Q

children under the age of 12 need what specified on their prescriptions

109
Q

what blood test to be monitored in metformin annually

110
Q

what four classes of antibiotics are contraindicated in pregnancy

A
  1. tetracyclines
  2. aminoglycosides
  3. sulphonamides + trimethoprim
  4. quinolones
111
Q

what blood thinner is contraindicated in pregnancy

112
Q

what diabetic medication is contraindicated in pregnancy

A

sulphonylureas

113
Q

4 side effects of sulfonylureas

A

Hypoglycaemia
Increased appetite and weight gain
SIADH
Liver dysfunction

114
Q

4 side effects of glitazones

A

Weight gain
Fluid retention
Liver dysfunction
Fractures

115
Q

Side effect of gliptins

A

pancreatitis

116
Q

short acting formulations of nifedipine should not be used for angina or hypertension due to what

A

large variations of blood pressure that can cause reflex tachycardia

117
Q

ciclosporin side effects

A

Hypertension
HyperK+
Gum hypertrophy
Hyperglycaemia

everything is increased!

118
Q

Alpha-blockers e.g. doxazosin, should be avoided for how long after taking sildenafil

119
Q

What combination of diuretics is contraindicated?

A

Potassium sparing diuretics x2
This can lead to life-threatening hyperkalaemia

e.g. amiloride + spironolactone

120
Q

What are two types of potassium sparing diuretics that should NOT be prescribed together as they can lead to hyperK+

A
  1. Epithelial sodium channel blocks e.g. amiloride + triamterene
  2. Aldosterone antagonists e.g. spironolactone + eplerenone
121
Q

4 indications of aldosterone antagonists e.g. spironolactone

A
  1. ascites
  2. heart failure
  3. nephrotic syndrome
  4. Conn’s syndrome
122
Q

what NSAID is contraindicated with any form of cardiovascular disease (IHD, PAD, CVD, CHF)

A

diclofenac

(this does not count for topical diclofenac)

123
Q

drug induced thrombocytopenia

what are 7 classes of drugs that can cause it

A
  1. quinines
  2. abciximab
  3. NSAIDs
  4. diuretics: furosemide
  5. Abx: penicillins, sulphonamides, rifampicin
  6. anticonvulsants: carbamazepine, valproate
  7. heparin/LMWH
124
Q

Complications of opioid miuse

A
  1. viral infections - HIV, Hep B/C
  2. bacterial infection
  3. VTE
  4. overdose
  5. pysch social issues
125
Q

5 types of drugs causing lung fibrosis

A
  1. amiodarone
  2. cytotoxic agents: bleomycin, busulphan
  3. RhA drugs: methotrexate, sulfasalazine
  4. Nitrofurantoin
  5. DA agonists: bromocriptine, cabergoline, pergolide
126
Q

Drugs which should be prescribed by brand

A
  • modified release CCBs
  • antiepileptics
  • ciclosporin and tacrolimus
  • mesalazine
  • lithium
  • aminophylline and theophylline
  • methylphenidate
  • CFC-free formulations of beclometasone
  • dry powder inhaler devices
127
Q

NICE recommends that women who go through premature menopause before age 45 should consider taking what to prevent osteoporosis

A

HRT

continue until aged 50

128
Q

What 6 drugs can precipitate an attack of acute intermittent porphyria?

A
  1. barbiturates
  2. halothane
  3. benzos
  4. alcohol
  5. COCP
  6. sulphonamides
129
Q

what antibiotics lower seizure threshold in patients with epilepsy

A

ciprofloxacin
(quinolones)

130
Q

tamoxifen 4 adverse effects

A
  1. menstrual disturbances
  2. hot flushes
  3. VTE
  4. endometrial cancer
131
Q

6 indications for Botox use

A
  1. blepharospasm
  2. hemifacial spasm
  3. focal spasticity including cerebral palsy, stroke disabilities
  4. spasmodic torticollis
  5. severe hyperhidrosis
  6. achalasia
132
Q

What is the most appropriate time to take blood samples for therapeutic monitoring of digoxin levels?

A

At least 6 hours after last dose

133
Q

mefloquine side effects

A

nights or anxiety
suicide + self-harm

CONTRAINDICATED if history of anxiety, depression, schizophrenia or other psych disorders.

134
Q

restlessness, agitation
involuntary upward deviation of the eyes

what does this describe

A

oculogyric crisis

135
Q

what are 3 causes of oculogyric crisis (restlessness, upward deviation of eyes)

A
  1. antipsychotics
  2. metoclopramide
  3. post-encephalitic Parkinson’s disease
136
Q

what is the management of oculogyric crisis

A

IV anti-muscarinic
e.g. benztropine or procyclidine

137
Q

what 5 medications can exacerbate heart failure

A
  1. pioglitazones
  2. verapamil
  3. NSAIDs - can cause fluid retention
  4. glucosteroids
  5. class I antiarrhythmics e.g. flecainide
138
Q

what are the features of organophosphate insecticide poisoning i.e. accumulation of acetylcholine

A

salivation
lacrimation
urination
diarrhoea

SLUD
+ small pupils, muscle fasciculation, hypotension, bradycardia

139
Q

Management of organophosphate insecticide poisoning i.e. accumulation of acetylcholine

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