Pharm

Question 1

ALS Adrenaline doses

Answer 1

Anaphylaxis - 0.5ml 1:1000 IM
Arrest 10ml 1:10000 IV

Question 2

Management of alcohol issues

Answer 2

Benzos/chlordiazepoxide for acute withdrawale

Disulfuram - promotes abstinence
Acamprostate - reduced craving

Question 3

Allopurinol MOA and key interactions

Answer 3

Xanthine oxidase inhibitor
(used as urate lowing therapy in gout)
Interactions:
- Azathioprine (allo -> high level 6mcp)
- Cyclophosphamide (-> excess accumulation)
- Theophylline (-> inc plasma conc)

Question 4

Tx for Amiodarone induced thyroiditis

Answer 4

AIT T1 - goitre present - Tx = Carbimazole

AIT T2 - no goitre - Tx = Steroids

Question 5

Key adverse effects amiodarone

Answer 5

Hypo/hyperthyroid
Corneal deposits
Pulmo and liver fibrosis
Periph neuropathy
Photosensitivity
Brady + long QT

-> increased levels / effect of warfarin + digoxin

NB -> inc levels statins - more likely to get side effects (muscle pain)

Question 6

Side effects and cautions for Verapamil

Answer 6

SEs - Heart failure, constipation, hypotension, bradycardia, flushing

NB - should not be given with BBs

Question 7

Ciclosporin adverse effects

Answer 7

Nephro/hepatoxic
Hypertension + fluid retention
Hyperkal
Gingival hyperplasia
impaired glucose tolerance

Question 8

Tx for cocaine tox

Answer 8

Benzodiazepines

Chest pain = Benzo + GTN

Question 9

Diclofenac CIs

Answer 9

Associated with sig inc risk of cardio events than other NSAIDs

CIs;
Heart disease, CVD, PAD, CHF

Question 10

pt with AF
Presents generally unwell, N/V, lethargic, confusion, yellow-green vision

Answer 10

Digoxin toxicity

Question 11

Precipitating factors for Digoxin tox

Answer 11

1. Hypokal
   Age, renal failure, MI

Drugs; Amiodarone, verapamil, diltiazem, diuretics, spiro

Question 12

Drug monitoring for Statins

Answer 12

LFTs at baseline, 3mo and 12mo

Question 13

Drug monitoring for ACEi

Answer 13

U&Es at baseline and when increasing dose
Annual U&E

Question 14

Drug monitoring for Amiodarone

Answer 14

TFT and LFT every 6 mo
CXR before Tx

Question 15

Drug monitoring for Methotrexate

Answer 15

FBC, LFT, U&E

Question 16

Drug monitoring for Azathioprine

Answer 16

FBC and LFT

Question 17

Drug monitoring for Litium

Answer 17

Lithium levels, TFT, U&E

Question 18

Drug monitoring for Sodium Val

Answer 18

LFT

Question 19

Drug monitoring for Glitazones

Answer 19

LFT

Question 20

Classic causes of drug induced thrombocytopenia

Answer 20

Quinine, NSAIDs, diuretics, Abx

Question 21

Drug induced urinary retention

Answer 21

TCAs (amitryptiline), Opiods, anticholinergics

Question 22

Common adverse effects for Finasteride

Answer 22

Indications; BPH, male pattern baldness

Adverse effects; Impotence, decreased libido, ED, gyno

Question 23

Monitoring for standard vs LMWH

Answer 23

Standard - APTT
LMWH - anti Xa (but not routinely monitorred)

Question 24

BiPolar patient
Course tremor, hyperreflexia, acute confusion, polyuria, seizure, coma

Answer 24

Lithium Toxicity
Tx = IVF, haemodialysis if severe

Bloods -> hypernat
Precipitated by; dehydration, renal failure, diuretics

Question 25

Adverse effects of macrolides

Answer 25

(clari, azithro, erythro) Prolong QT interval, GI side effects, cholestatic jaundice P450i - STOP STATINS when starting

Question 26

Mech of action of metformin, + Adverse effects and CIs

Answer 26

Inc insulin sensitivity, dec hepatic gluconeogenesis Adverse effects; - GI upset CIs - CKD, recent MI, aki, sepsis

Question 27

Tx for Opioid tox and dependence

Answer 27

Tox - Naloxone Dep - methadone and buprenorphine

Question 28

Drug tox: Hyperventilation, tinnitus, sweating/pyrexia, N/V, seizures and coma

Answer 28

Salicylate OD (Aspirin() Tx; Urine alkalisation with IV bicarb Haemodialysis

Question 28

Tx for ethylene glycol poisoning

Answer 28

Fomepizole Haemodialysis if severe

Question 28

Drug tox; Salivation/lacrimation, bradycardia, diarrhoea, small pupils

Answer 28

Organophosphate poisoning Tx = atropine

Question 28

Tx for benzo OD

Answer 28

Flumezanil

Question 28

Tx for TCA OD

Answer 28

IV bicarb - helps reduce risk of seizures

Question 28

Tx for Heparin OD

Answer 28

Protamine sulphate

Question 28

Tx for BB od

Answer 28

Atropine If resistant - glucagon

Question 29

Tx for methanol OD

Answer 29

Fomepizole/ethanol Haemodialysis if severe

Question 29

Inhibitors of P450 system

Answer 29

SICK FACES.COM Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Alcohol (binge), Chloramphenicol, Erythromycin, SSRIs, Ciprofloxacin, Omeprazole, Metronidazole

Question 29

Tx for Iron OD

Answer 29

Desferriozamine

Question 29

Tx for cyanide poisoning

Answer 29

Hydroxocobalamin

Question 29

Inducers of P450 system

Answer 29

(CRAP GPS induce rage) Carbimazole, Rifampicin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbitone, St Johns Wort

Question 30

CIs / SEs of Phosphodiesterase type V inhibitors (sildenafil/tadalafil)

Answer 30

SEs - blue vision, flushing, nasal congestion CIs - pts taking nitrates (nicorandil), Hypotension, recent stroke/MI

Question 31

Quinolones (cipro) side effects

Answer 31

Lower seizure threshold, tendon damage, lengthens QT Avoid in pregnancy and breastfeeding

Question 32

Common side effects of sulfonylureas (Glimepiride)

Answer 32

Hypoglycaemic episodes Inc appetite + weight gain SIADH

Question 33

Common side effects Glitazones (Pioglitazone)

Answer 33

weight gain Fluid retention Liver dysfunction

Question 34

Adverse effects of tamoxifen

Answer 34

Menstrual disturbances Hot flushes VTE endometrial cancer

Question 35

Drug tox - dry mouth, dilated pupils, agitation, sinus tachy, blurred vision

Answer 35

TCA OD ecg - sinus tachy, wide QRS, long QT Tx = IV bicarb

Question 36

Clari and cardiac

Answer 36

Clari associated with inc risk cardiac events/MIs/Strokes (thought to be due to rupture of existing plaques

Question 37

BB adverse effects

Answer 37

Fatigue, raynauds, worsening of asthma/bronchospasm, psoriasis, insomnia NB - should be titrated down slowly to avoid risk of rebound myocardial ischaemia Propranolol - less cardioselective that Bisoprolol