Pharm & tox

Question 1

Indications for IViG (10)

Answer 1

Primary and 2ry immunodeficiency
ITP
Myasthenia gravis
GBS
Kawasaki Disease
TEN
Pneumonitis induced by CMV following transplantation
Low serum IgG after haematopoetic stem cell transplant for malignancy
Chronic Inflammatory demyelinating polyradiculopathy

Question 2

Cocaine - cardio effects (5)

Answer 2

MI
Tachy/brady
HTN
QRS widening and QT prolongation
Aortic dissection

Question 3

Cocaine - neuro effects (4)

Answer 3

Seizures
Mydriasis
hypertonia
hyperreflexia

Question 4

Cocaine psych effects (3)

Answer 4

Agitation
Psychosis
Hallucinations

Question 5

Cocaine other effects (4)

Answer 5

Ischaemic colitis post ingestion
Hyperthermia
Metabolic acidosis
Rhabdomyolysis

Question 6

Cocaine Mx

Answer 6

Chest pain - benzos + GTN, if MI -> PPCI

HTN - benzos + sodium nitroprusside

Question 7

Common drug causes of Utricaria (4)

Answer 7

Aspirin
PEnicillins
NSAIDs
OPiates

Question 8

Octreotide uses (6)

Answer 8

Carcinoid syndrome
Acute Rx of variceal haemorrhage
ACromegaly
Prevent Cx post pancreatic Sx
VIPomas
Refractory diarrhoea

Question 9

Octreotide SEs

Answer 9

Gallstones - 2ry to bilary stasis

Question 10

Indications for haemodialysis in salicylate poisoning (6)

Answer 10

• serum concentration >700
• metabolic acidosis resistant to Rx
• Acute renal failure
• pulmonary oedema
• Seizures
• coma

Question 11

Mechanism of action Sarin gas

Answer 11

acetylcholinesterase inhibitor

synthetic organophosphatase

Question 12

Effects of increased ACh (ie sarin gas) DUMBELS

Answer 12

Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweating

Question 13

Trastuzumab (herceptin) MoA, indication

Answer 13

HER2/neu monoclonal Ab

Used in metastatic breast Ca

Question 14

Trastuzumab (herceptin) adverse effects

Answer 14

flu-like symptoms and diarrhoea are common
cardiotoxicity: more common when anthracyclines (-rubicin) have also been used. An echo is usually performed before starting treatment

Question 15

Drugs that trigger Acute Intermittent Porphyria (6)

Answer 15

Barbiturates - eg thiopentone
Halothane 
Benzos
Alcohol 
OCP
Sulphonamides

Question 16

Drug induced thrombocytopaenia (7)

Answer 16

Quinine
Abciximab
NSAIDs
Diuretics - furosemide
ABx - penicillins, sulphonamides, rifampicin
Anticonvulsants - CBZ, valproate
Heparin

Question 17

Lithium monitoring range, timing

Answer 17

0.4-1.0 mmol/l

12h post dose

Question 18

Ciclosporin monitoring timing

Answer 18

trough levels immediately before dose

Question 19

Digoxin monitoring timing

Answer 19

at least 6h post dose

Question 20

Phenytoin monitoring timing & indications (3)

Answer 20

Trough immediately pre next dose

Adjustment of dose, Suspected toxicity, detection of nonadherence

Question 21

Abx to avoid in pregnancy (4)

Answer 21

Tetracyclines
Aminoglycosides
Sulphonamides and trimethoprim
Ciprofloxacin

Question 22

Drugs to Avoid in pregnancy (7)

Answer 22

Statins
ACEi, ARBs
Warfarin 
Sulfonylureas
Retinoids - inc topical 
Cytotoxic agents
Majority of anti-convulsants (lamotrigine/Keppra are the preferred choice)

Question 23

Causes of raised anion gap (4)

Answer 23

Lactic acidosis
Ketoacidosis
Renal failure - high urate
Toxins - methanol, ethylene glycol, salicylates

Question 24

Drugs that undergo extensive first pass metabolism (9)

Answer 24

Aspirin 
Isosorbide dinitrate
GTN
Lignocaine
Propranolol
Verapamil 
Isoprenaline 
Testosterone
Hydrocortisone

Question 25

Drugs that exhibit zero order kinetics (4)

Answer 25

phenytoin
salicylates (e.g. high-dose aspirin)
heparin
ethanol

Question 26

Atropine MoA, physiological effects and use

Answer 26

Anti-muscarinic
Tachycardia and mydriasis (dilatation)
Organophosphate poisoining