pharm Flashcards
1
Q
PDE5 inhibitors (e.g. sildenafil) are contraindicated by which 2 medications
A
Nitrates and nicorandil
2
Q
PDE5 inhibitors (e.g. sildenafil) are used in treatment of erectile dysfunction and…
A
pulmonary hypertension
3
Q
3 contraindications to PDE5 inhibitors (e.g. sildenafil - Viagra)
A
- Meds - nitrates or nicorandil
- Hypotension
- MI/stroke in last 6 months
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
5
Q
What drug causes blue vision
A
Viagra (sildenafil)
6
Q
What drug causes green/yellow vision in toxicity
A
Digoxin
7
Q
Digoxin level is only monitored in suspected toxicity. When should they be measured?
A
Within 8-12 hours of last dose
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
9
Q
Features of digoxin toxicity
A
Nausea + vomiting
Confusion
Yellow-green vision
Gynaecomastia
Arrhythmias
10
Q
What is an endocrine change with digoxin toxicity
A
Gynaecomastia
+ anorexi
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
12
Q
Management of digoxin toxicity - 3 steps
A
- Digibind
- Correct arrhythmias
- Monitor potassium
13
Q
What is the most common side effect of finasteride (5-alpha reductase inhibitor)
A
Gynaecomastia
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
15
Q
2 indications of finasteride
A
- BPH
- Male pattern baldness
16
Q
Finasteride effects on PSA level
A
Reduces serum PSA
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
18
Q
When and what bloods should be monitored for amiodarone
A
TFTs, LFTs, U+Es, CXR before starting
TFTs, LFTs every 6 months
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
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
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
22
Q
When and what bloods should be monitored for sodium valproate
A
LFTs, FBC before starting
LFTs periodically during first 6 months
23
Q
When and what bloods should be monitored for glitazones
A
LFTs before starting
LFTs regularly during treatment
24
Q
what anticoagulant is okay for use in CKD4
A
warfarin
25
for iodine-containing x-ray contrast media e.g. angiography, when should metformin be held to avoid contrast renal impairment
hold metformin on day of procedure and for 48 hours afterwards
26
mechanism of action of metformin
- activates AMPK
- increases insulin sensitivity
- decreases hepatic gluconeogenesis
27
when should ciclosporin levels be taken
trough levels
IMMEDIATELY BEFORE dose
28
lithium levels when should they be monitored
12 hours post-dose
29
phenytoin levels - trough when should dose be checked
IMMEDIATELY BEFORE dose
(if adjusting dose, or suspected toxicity)
30
Lithium toxicity may be triggered by what 3 things
1. Dehydration
2. Renal failure
3. Drugs - diuretics, ACEi/ARBs, NSAIDs and metronidazole
31
Lithium toxicity signs
Coarse tremor
Hyperreflexia
Confusion
Seziures
++ urine
32
Management of lithium toxicity
- Fluids
- Haemodialysis in severe toxicity
- Sodium bicarb sometimes to promote lithium excretion
33
What is the most appropriate dose of adrenaline to give during a cardiac arrest?
10ml (1mg) 1:10000 IV
or 1ml 1:1000 IV
34
which diabetic medication can sometimes lead to low B12
metformin
35
Emergency management of opioid overdose
IV or IM naloxone
36
First line treatments in opioid detoxification
Methadone
Buprenorphine
37
compliance for opioid detox medication (e.g. methadone or buprenorphine) is monitored using..
urinalysis
38
how long does opioid detox usually last up to in:
(a) inpatient setting
(b) community
(a) inpatient setting - 4 weeks
(b) community - 12 weeks
39
methadone mechanism of action
mu-opioid receptor agonist
40
buprenorphine mechanism of action
mu-opioid receptor partial agonist
kappa-opioid antagonist
41
Carbon monoxide toxicity leads to which skin/mucosa changes
Pink skin and mucosa
42
Typical carboxyhaemoglobin % levels in:
(a) non-smokers
(b) smokers
(c) symptomatic
(d) severe toxicity
(a) non-smokers <3%
(b) smokers <10%
(c) symptomatic 10-30%
(d) severe toxicity >30%
43
Management of carbon monoxide poisoning
100% high flow O2 non-rebreather
Continue Rx for 6 hours minimum
Target sats 100%
Continue treatment until all symptoms resolved
44
St john's wort effect on P450 system
P450 inducer
Reduces effect of COCP and warfarin etc
45
On average, what percentage of patients will eventually take antibiotics if delayed Abx strategy is employed?
33%
46
MDMA poisoning leads to what electrolyte disturbance
HYPOnatraemia
47
Management of MDMA poisoning
Supportive
Dantrolene for hyperthermia
48
NICE recommend that the dose of metformin should be reviewed and stopped if levels are above:
(a) creatinine
(b) eGFR
(a) Cr >130 - review, >150 - stop
(b) eGFR <45 - review, <30 - stop
49
Metformin should be titrated slowly, how long should be left between dose changes
Leave at least 1 week before increasing dose
50
4 drug groups that commonly cause urticaria
Aspirin
Penicillin
NSAIDs
Opiates
51
What drugs can lead to lithium toxicity
diuretics
ACEi/ARBs
NSAIDs
metronidazole
therefore HTN patients should be on CCB if possible
52
what antibiotics interact with statins
MACROLIDES
i.e. erythro/clari
53
Alcoholic patients should receive what supplementation
THIAMINE ONLY
54
Drugs used for management of alcohol misuse for detox
- Benzodiazepines for acute withdrawal
- Disulfram: promotes abstinence, causes reaction. Contraindicated in IHD and psychosis
- Acamprosat: reduces craving, weak antagonist of NMDA receptors
55
If woman is >55 or no periods for >1 year then which HRT is chosen:
continuous or cyclical
continuous
56
side effects of alpha-blockers
postural hypotension
drowsiness
cough
SOB
57
risk of cataract surgery with a-blockers
intra-operative floppy iris syndrome
58
alpha blockers what are the 2 main indications for use
benign prostatic hyperplasia
hypertension
59
women on statins wanting to try for a baby - what is the advice
stop 3 months before conception
due to risk of congenital defects
60
At what point do patients have a repeat cholesterol test done to test the effectiveness of the statin?
At 12 weeks (3 months)
Aims to reduce non-HDL by >40%
Lipid profile and liver function tests are done
61
Lipid profile and liver function tests are rechecked after 3 months (12 weeks) from starting a statin.
What is the aim for the cholesterol?
>40% reduction in non-HDL levels
62
Familial Hypercholesterolaemia - What is the inheritance trait
autosomal dominant
63
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?
No prophylactic treatment needed if asymptomatic
64
what does vitamin A (retinoid) deficiency cause
night blindness (nyctalopia)
65
what does vitamin B1 (thiamine) deficiency cause
Beri-beri syndrome: polyneuropathy, Wernicke's
Heart failure
66
what does vitamin B3 (niacin) deficiency cause
Pellagra
- dermatitis, diarrhoea, dementia
67
what does vitamin B6 (pyridoxine) deficiency cause
anaemia
irritability
seizures
68
what does vitamin B7 (biotin) deficiency cause
dermatitis
seborrhoea
69
what does vitamin B9 (folic acid) deficiency cause
megaloblastic anaemia
neural tube defects
70
what does vitamin C (ascorbic acid) deficiency cause
scurvy
- gingivitis
- bleeding
71
what does vitamin D (ergo/cholecalciferol) deficiency cause
rickets
osteomalacia
72
what does vitamin E (tocopherol) deficiency cause
mild haemolytic anaemia in newborn infants
ataxia
peripheral neuropathy
73
what does vitamin K (napthoquinone) deficiency cause
haemorrhagic disease of newborn
bleeding
74
causes of hypovolemic hyponatraemia (i.e. clinically dehydration)
diuretics
renal failure
Addison's crisis
75
cause of euvolaemic hyponatraemia
SIADH
76
causes of hypervolaemic hyponatraemia
heart failure
liver failure
nephrotic syndrome
77
treatment of euvolaemic hyponatraemia (SIADH)
- fluid restrict
- meds: demeclocycline, vaptans
78
treatment of hypervolaemic hyponatraemia (i.e. heart failure, liver failure, nephrotic syndrome)
- fluid restrict
- meds: loop diuretics, vaptans
79
Vasopressin/ADH receptor antagonists (vaptans) mechanism of action
V2 receptor antagonists
Selective water diuresis
Spares electrolytes
80
Overcorrection of hyponatraemia too quickly can cause osmotic demyelination syndrome. therefore to avoid this, sodium levels are only raised by how much per day
4-6 mmol/l over 24 hours
81
what BMI is classed as underweight
< 18.5
82
What is a normal BMI
18.5-25
83
What are the BMI ranges for:
- overweight
- obese
- clinically obese
- morbidly obese
- overweight 25-30
- obese 30-35
- clinically obese 35-40
- morbidly obese >40
84
Patients with acute severe hyponatraemia should be urgently admitted to hospital when their serum sodium concentration is less than what
Less than 125mmol/L
85
common malignant cause of SIADH
small cell lung cancer
86
what drugs can cause SIADH
sulfonylureas
SSRIs
carbamazepine
tricyclic antidepressants
87
urine osmolality and sodium concentration in SIADH
Urine osm - inappropriately high
Urine sodium conc - high
88
management of SIADH
- fluid restiction
- demeclocyclin
- ADH (vasopressin) receptor antagonists
89
What is NICE advice with regards to physical activity?
Each week at least 150mins of moderate intensity aerobic activity or 75mins of vigorous intensity aerobic activity
90
4 causes of Hypokalaemia with hypertension
1. Cushing's syndrome
2. Conn's syndrome
3. Liddle's syndrome
4. 11-b hydroxylase deficiency
91
4 causes of Hypokalaemia without hypertension
1. diuretics
2. GI loss
3. renal tubular acidosis
4. bartter's syndrome
5. gitelman syndrome
92
Consider the possibility of familial hypercholesterolaemia and investigate as described in familial hypercholesterolaemia if the patient has one of which two criteria?
1. Total cholesterol >7.5
2. Family history of premature coronary heart disease
93
rifampicin side effects
hepatitis
orange secretions
liver enzyme INDUCER
94
isoniazid side effects (TB drug)
hepatitis
agranulocytosis
peripheral neuropathy - prevent with pyridoxine, vitamin B6
liver enzyme INHIBITOR
95
pyrazinamide side effects
hyperuricaemia - causing gout
arthralgia
hepatitis
96
ethambutol side effects
optic neuritis
- check visual acuity before and during treatment
97
Bendroflumethiazide side effects
Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance
98
b-blockers side effects
bronchospasm
fatigue
cold peripheries
99
Who is responsible for collating and assessing the Yellow Card reports?
Medicines and Healthcare products Regulatory Agency (MHRA)
100
fast onset
sweating
tremor
confusion
hyper-reflexia
what is the diagnosis:
serotonin syndrome or neuroleptic malignant syndrome
serotonin syndrome
101
What is the treatment of serotonin syndrome and neuroleptic malignant syndrome
IV fluids
Benzodiazepines
Dantrolene - for severe NMS
102
What is the difference in reflexes and onset between serotonin syndrome and neuroleptic malignant syndrome?
Serotonin syndrome - hyperreflexia, fast onset
Neuroleptic malignant syndrome - hyporeflexia, slow onset
103
what two side effects is azithromycin associated with
tinnitus
hearing loss
104
erythromycin and clarithromycin do what to liver enzymes
P450 inhibitor
105
adverse effects of amiodarone
thyroid - hyper/hypo
corneal deposits
pulmonary fibrosis
liver fibrosis
peripheral neuropathy
photosensitivity
prolonged QT interval
bradycardia
106
2 important drug interactions of amiodarone include
1. decreased warfarin metabolism therefore high INR
2. increased digoxin levels
107
St Johns wort and SSRIs can lead to ...
serotonin syndrome
108
children under the age of 12 need what specified on their prescriptions
AGE
109
what blood test to be monitored in metformin annually
U+Es
110
what four classes of antibiotics are contraindicated in pregnancy
1. tetracyclines
2. aminoglycosides
3. sulphonamides + trimethoprim
4. quinolones
111
what blood thinner is contraindicated in pregnancy
warfarin
112
what diabetic medication is contraindicated in pregnancy
sulphonylureas
113
4 side effects of sulfonylureas
Hypoglycaemia
Increased appetite and weight gain
SIADH
Liver dysfunction
114
4 side effects of glitazones
Weight gain
Fluid retention
Liver dysfunction
Fractures
115
Side effect of gliptins
pancreatitis
116
short acting formulations of nifedipine should not be used for angina or hypertension due to what
large variations of blood pressure that can cause reflex tachycardia
117
ciclosporin side effects
Hypertension
HyperK+
Gum hypertrophy
Hyperglycaemia
everything is increased!
118
Alpha-blockers e.g. doxazosin, should be avoided for how long after taking sildenafil
4 hours
119
What combination of diuretics is contraindicated?
Potassium sparing diuretics x2
This can lead to life-threatening hyperkalaemia
e.g. amiloride + spironolactone
120
What are two types of potassium sparing diuretics that should NOT be prescribed together as they can lead to hyperK+
1. Epithelial sodium channel blocks e.g. amiloride + triamterene
2. Aldosterone antagonists e.g. spironolactone + eplerenone
121
4 indications of aldosterone antagonists e.g. spironolactone
1. ascites
2. heart failure
3. nephrotic syndrome
4. Conn's syndrome
122
what NSAID is contraindicated with any form of cardiovascular disease (IHD, PAD, CVD, CHF)
diclofenac
(this does not count for topical diclofenac)
123
drug induced thrombocytopenia
what are 7 classes of drugs that can cause it
1. quinines
2. abciximab
3. NSAIDs
4. diuretics: furosemide
5. Abx: penicillins, sulphonamides, rifampicin
6. anticonvulsants: carbamazepine, valproate
7. heparin/LMWH
124
Complications of opioid miuse
1. viral infections - HIV, Hep B/C
2. bacterial infection
3. VTE
4. overdose
5. pysch social issues
125
5 types of drugs causing lung fibrosis
1. amiodarone
2. cytotoxic agents: bleomycin, busulphan
3. RhA drugs: methotrexate, sulfasalazine
4. Nitrofurantoin
5. DA agonists: bromocriptine, cabergoline, pergolide
126
Drugs which should be prescribed by brand
- modified release CCBs
- antiepileptics
- ciclosporin and tacrolimus
- mesalazine
- lithium
- aminophylline and theophylline
- methylphenidate
- CFC-free formulations of beclometasone
- dry powder inhaler devices
127
NICE recommends that women who go through premature menopause before age 45 should consider taking what to prevent osteoporosis
HRT
continue until aged 50
128
What 6 drugs can precipitate an attack of acute intermittent porphyria?
1. barbiturates
2. halothane
3. benzos
4. alcohol
5. COCP
6. sulphonamides
129
what antibiotics lower seizure threshold in patients with epilepsy
ciprofloxacin
(quinolones)
130
tamoxifen 4 adverse effects
1. menstrual disturbances
2. hot flushes
3. VTE
4. endometrial cancer
131
6 indications for Botox use
1. blepharospasm
2. hemifacial spasm
3. focal spasticity including cerebral palsy, stroke disabilities
4. spasmodic torticollis
5. severe hyperhidrosis
6. achalasia
132
What is the most appropriate time to take blood samples for therapeutic monitoring of digoxin levels?
At least 6 hours after last dose
133
mefloquine side effects
nights or anxiety
suicide + self-harm
CONTRAINDICATED if history of anxiety, depression, schizophrenia or other psych disorders.
134
restlessness, agitation
involuntary upward deviation of the eyes
what does this describe
oculogyric crisis
135
what are 3 causes of oculogyric crisis (restlessness, upward deviation of eyes)
1. antipsychotics
2. metoclopramide
3. post-encephalitic Parkinson's disease
136
what is the management of oculogyric crisis
IV anti-muscarinic
e.g. benztropine or procyclidine
137
what 5 medications can exacerbate heart failure
1. pioglitazones
2. verapamil
3. NSAIDs - can cause fluid retention
4. glucosteroids
5. class I antiarrhythmics e.g. flecainide
138
what are the features of organophosphate insecticide poisoning i.e. accumulation of acetylcholine
salivation
lacrimation
urination
diarrhoea
SLUD
+ small pupils, muscle fasciculation, hypotension, bradycardia
139
Management of organophosphate insecticide poisoning i.e. accumulation of acetylcholine
Atropine
