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General Med > Pharm > Flashcards

Pharm Flashcards

1
Q

CYP450 inducers

A

PC BRAS
Phenytoin
Carbamazepine

Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas
St Johns Wort
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2
Q

CYP450 inhibitors

A

AO DEVICES
Allopurinol/Antifungal/Amiodarone
Omeprazole/Cimetidine

Disulfram
Erythromycin/clarithromycin 
valproate
Isonazid
Ciprofloxacin
Ethanol (acute intoxication)

Sulphonamides
Grapefruit

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3
Q

Drugs impacted by CYP450

A 
Warfarin
COCP
Steroids
TCAs
Statins
Pethindine 
theophyline
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4
Q

Narrow therapeutic windows

A 
Gentamicin
Warfarin
Lithium
Digoxin
THeophylline
Methotrexate
Phenytoin
Insulin
Ciclosporin
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5
Q

Metformin interaction

A

Cimetidine (inhibits renal elimination)

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6
Q

Gentamicin

A

Loop diuretics (renal failure risk)

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7
Q

ACEI

A

Potassium sparing diuretics (risk of hyperkalaemia)

Metformin (enhances hypoglycaemic effect)

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8
Q

Statins

A 
Macrolide
Amiodarone (increased statin concentration therefore risk of rhabdomyolysis)
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9
Q

Thiazide

A

PPI (hyponatraemia)

Lithium (increased toxicity)

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10
Q

Cardiac arrest drugs

A 
Adrenaline 10ml of 1 in 10000 IV
Amiodarone 300mg (if shockable)
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11
Q

Anaphylaxis drugs

A

Adrenaline 0.5ml of 1 in 1000 IM
Hydrocortisone 200mg IV
chlorphenamine 10mg IV

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12
Q

Seizure drugs

A

lorazepam IV 4mg

Diazepam 10mg PR

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13
Q

Hypoglycaemia drugs

A

10% glucose 150ml IV
20% glucose 75ml IV
Glucagon IM 1mg (no IV access)

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14
Q

Hyperkalaemia drugs

A

10% calcium gluconate 10ml over 5 mins

THEN - 10% glucose 250ml IV plus 10 units of antrapid insulin over 30 mins

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15
Q

Bradycardia drugs

A

Atropine 500mcg IV (every 3-5 mins to max 3mg - 6 doses)

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16
Q

SVT (without adverse signs) drugs

A

Adenosine 6mg

can be followed by a further 12mg and another if unsuccessful

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17
Q

VT drugs

A

Amiodarone 300mg IV over 20-60 min

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18
Q

Rapid tranquilisation of at risk patient

A

lorazapam 1-2mg PO (or 2-4 IM)

Haloperidol 1.5-3mg PO (or 5-10mg IM)

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19
Q

WHO analgesic ladder

A

Step 1: non-opioid (aspirin, paracetamol or NSAID)
Step 2: Weak opioid (codeine)
Step 3: strong opioid (morphine, fentanyl)

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20
Q

Non-opioid analgesia

A

Paracetamol 0.5-1g QDS
Ibuprofen 400mg QDS
Diclofenac 50mg PO 8 hourly
Naproxen 0.5-1g daily

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21
Q

Ibuprofen CI

A

Gastritis and asthma Hx

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22
Q

Weak Opioid analgesia

A

Dihydrocodeine

Codeine

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23
Q

Compound analgesia

A

co-codamol (paracetamol) 8/500mg or 30/500mg
co-dydramol (dihydrocodiene + paracetamol) 10/500mg
co-codaprin (aspirin)

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24
Q

Strong opioids

A 
Morphine (PO/IV/IM/TD)
oxycodone 
Tramadol 
Buprenorphine 
Fentanyl
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25
Acute morphine dose
0.1-0.2 mg/kg + 0.05mg/kg every 5 mins till pain resolved
26
Renal colic pain mx
PR diclofenac
27
Drugs to stop before surgery
``` I LACK OP Insulin (variable) Lithium (day before) Anticoagulants/antiplatelets variable cOCP/HRT (4 weeks before) K-sparing diuretics (day of surg.) Oral hypoglycaemics (varys) Periondopril + ACEI (day before) ```
28
VT causes
Infarction Myocarditis ``` QT syndrome Valve abnormalities Iatrogenic Cardiomyopathy K+/Mg/O2/acidosis ```
29
Sildenafil CI
- patients taking nitrates (nicorandil) - hypotension - recent stroke or MI (6 months)
30
Post MI secondary prevention
``` Conservative: diet, exercise Medication: - dual antiplatelet - ACEI - Beta blocker - Statin ```
31
Causes of raised prolactin
- prolactinoma - pregnancy - oestrogens - physiological stress - acromegaly - PCOS - primary hypothyroidism
32
Amiodarone monitoring
TFT, LFT
33
Levetiracetam monitoring
No routine monitoring needed
34
Methotrexate
FBC, LFT, U&Es
35
Antibiotic effecting LFTs
Co-amoxiclav, erythromycin, fluclox Causes cholestasis
36
Drugs causing liver cirrhosis
Methotrexate Methyldopa Amiodarone
37
Drugs causing lung fibrosis
``` Amiodarone Cytotoxic -busulphan - bleomycin Anti-rheumatoid drugs - methotrexate - sulfasalazine - gold Nitrofuratoin Ergot derived dopamine receptor agonists - bromocriptine, cabergoline, pergolide ```
38
Drugs causing agranulocytosis
``` Clozapine Carbimazole/propylthiouracil carbamazepine Chlorampenicol/penicillin/co-trimoxazole Mirtazapine Methotrexate ```
39
Benzodiazapine over dose reversal
Flumazenil | GABA-antagonist
40
Adverse effects of loop diurectics
- hypotension - low Na, K - hypochloraemic alkalosis - OTOTOXICITY - Hypocalcaemia - Renal impairment - hyperglycaemia - gout
41
Statins doses
Primary prevention 20mg OD Atorvastatin | secondary prevention 80mg atorvastatin
42
Statin SE
``` Myopathy Liver impairment (stop if >=3 abnormal LFT measurments) ```
43
Drugs to avoid in renal failure
- AB: tetracycline, nitrofurantoin - NSAIDs - lithium - metformin
44
Azathioprine pre-prescribe check
``` TPMT deficiency (thiopurine methyltransferase) ``` SE: - bone marrow depression - nause and vomitiing - pancreatits
45
Animal bite antibiotic
Co-amoxiclav
46
Adrenaline dose in cardiac arrest
1 mg of 1:10,000
47
Gentamicin SE
Ototoxicity nephrotoxicity CI of Gent: - myasthenia gravis
48
Phase 1 drug metabolism (x3)
Oxidation Reduction hydrolysis
49
Phase 2 drug metabolism
Conjugation
50
MAOI (eg phenelzine) SE
- hypertensive reactions | - anticholinergic effects
51
Gynaecomastia causing drugs
``` Digoxin Izonasid Spironolactone Cimetidine/cannabis Oestrogens ``` Anabolic steroids Gonadorelin analogues: goserelin, buserelin Finasteride
52
Metformin SE
GI disturbance | Lactic acidosis
53
Sulphonylureas (Glimepiride)
Hypoglycaemia Increased appetite and weight gain SIADH Liver dysfunction
54
Glitazones
Weight gain Fluid retention Liver dysfunction fractures
55
St Johns wort
CYP450 inducer
56
Lithium toxicity precipitants and features
Precipitated by: - dehydration - renal failure - diuretics - ACEI - NSAIDs - metroodazole Features: - coarse tremor - hyperreflexia - acute confusion - seizure - coma
57
Digoxin toxicity precipitants
``` Hypokalaemia raised age renal failure MI Low magnesium Raised Calcium, sodium Acidosis low albumin hypothermia hypothyroidism Drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone, ciclosporin ```
58
Mangement of digoxin toxicity
digibind correct arrhythmias monitor potassium
59
Zero-order kinetics
Describes metabolism which is independent of the concentration of the reactant. This is due to metabolic pathways becoming saturated resulting in a constant amount of drug being eliminated per unit time
60
Features of opiod misuse
``` Rhinorrhoea needle tracks pinpoint pupils drowsiness watering eyes yawning ```
61
Migraine prophylaxis
Topiramate or propranolol
62
Absolute contraindications to thrombolysis
``` Active internal bleeding Recent haemorrhage, Trauma or surgery (including dental extraction) Coagulation and bleeding disorders Intracranial neoplasm Stroke < 3 months Aortic dissection Recent head injury Pregnancy Severe hypertension ```
63
Mx of salicylate overdose
ABC + charcoal urinary alkalinization with IV sodium bicarb Haemodialysis
64
Bisphosphonates SE
Osteonecrosis GORD, oesophageal ulcers Atypical stress fractures of proximal femoral shaft

General Med (17 decks)

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