Pharmac Flashcards
1
Q
H/o Leg cramps + Visual disturbances + ringing in ears + Prolonged QRS and QT + Hypoglycaemia + Metabolic Acidosis
Salicylate= Normal.
A
Quinine Toxicity.
2
Q
Quinine Toxicity.
A
H/o Leg cramps + Visual disturbances + ringing in ears + Prolonged QRS and QT + Hypoglycaemia + Metabolic Acidosis
Salicylate= Normal.
3
Q
How to differentiate bw quinine toxicity and aspirin toxicity ?
A
If salicylate level is normal.
It’s not aspirin toxicity
4
Q
Does cocaine induce labour ?
A
Yes
5
Q
2 week history of visual field defect—scotomas + Hearing loss—SNHL+ Numbness in hands
A
Mercury poisoning
6
Q
MI Secondary to Cocaine. Rx:
A
IV Lorazepam
7
Q
Allopurinol is strongly associated with SCARs, especially in individuals with the____allele
A
HLA-B*5801
8
Q
Smoking is a P450 ___
A
enzyme inductor
9
Q
Enzyme inducers mnemonic :
A
SCRAP GPS (inducers)
Sulphonylureas/Smoking
Carbemazepines
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
St John’s Wort
10
Q
monoclonal antibody that acts on the HER2/neu receptor
A
Trastuzumab
11
Q
Recommend Adult Life Support (ALS) adrenaline doses
A
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
12
Q
Aspirin MOA:
A
Decreases the formation of thromboxane A2(Texas themed shoe)
Non reversible inhibitor of COX 1 and COX 2
13
Q
Doxazosin MOA:
A
Alpha 1 Antagonist
14
Q
SSRI + MDMA= High temp + Hyperreflexia + Myoclonus + Rigidity. Dx?
A
Serotonin Syndrome.
15
Q
Rx for Serotonin Syndrome:
A
Cyproheptadine
16
Q
Lithium toxicity , 1st line Rx:
A
IV saline.
17
Q
Teicoplanin MOA:
A
Inhibits Bacterial cell wall formation
18
Q
Adrenaline induced ischaemia - Skin turns blue
A
Phentolamine
19
Q
Beta-blocker OD Rx:
A
Initial Rx- atropine, glucagon in resistant cases
20
Q
Local anesthetic toxicity can be treated with :
A
IV 20% lipid emulsion
21
Q
Buprenorphine MOA
A
Used in opioid Dependance.
MOA: partial agonist of the mu-opioid receptor and an antagonist of the kappa-opioid receptoR
22
Q
Zero order kinetics mnemonic and examples ?
A
He is zero, because he lost love—Drank Alcohol—had MI and Fits.
Ethanol
Salicylates ( High dose Aspirin )
Phenytoin
23
Q
Underlying mechanism of Cyanide poisoning ?
A
Inhibition of cytochrome C oxidase.
24
Q
H/O burning house + Headache + confusion + Flushed face + Bitter Almond taste. Dx?
A
Cyanide Poisoning
Rx: Hydroxycobalamin.
25
Rx of Cyanide poisoning:
Hydroxycobalamin
26
Amiloride selectively blocks the :
Epithelial sodium transport channels
27
Gingival hyperplasia Is caused by :
Amlodipine.
28
Electrolyte Imbalance seen in MDMA ?
Hyponatremia
29
Which drug will worsen the prognosis in PCM OD ?
If patient is on Carbamazapine therapy—Worsens the prognosis
Carbamazapine in an enzyme inducer
30
Most common S/e of cyclosporine :
Nephrotoxicity and Hepatotoxicity
31
anticholinesterase (acetylcholinesterase inhibitor)? S/e :
DUMBBELLS‘ mnemonic for cholinergic overdose
Diarrhoea
Urination
Miosis
Bradycardia
Bronchospasm
Emesis
Lacrimation
Lethargy
Salivation/Sweating (remember sweating is a cholinergic receptor mediated sympathetic nervous system action
32
Glycaemic control in diabetes may be worsened by:
Nicotinic Acid(Niacin)
33
Which diuretics precipitates Lithium Toxicity ?
Thiazide diuretics
34
A 43-year-old woman is about to start treatment with trastuzumab for metastatic breast cancer. What is the most important investigation to perform prior to initiating treatment?
Echo—As cardiac toxicity is common.
35
Cardiovascular S/E in cyclosporine ?
Hypertension
36
NSAID side effect:
Thrombocytopenia—Leads to Bleeding
37
Octreotide MOA:
Somatostatin Analogue( Octagon shaped stop sign )
38
Octreotide S/E:
BIlliary stasis—Gall stones.
39
Aspiring Overdose Rx:
Activated charcoal if admitted within one hour.
40
safer opioid to use in patients with moderate to end-stage renal failure:
Oxycodone
41
Bromocriptine may cause:
Pulmonary Fibrosis ( 6-month history of persistent dry cough and shortness of breath on exertio)
42
Bromocriptine + 6-month history of persistent dry cough and shortness of breath on exertio
Pulmonary Fibrosis
43
Beta-blockers can cause
Sleep disturbances and vivid dreams
44
antiarrhythmics disopyramide is an example of a:
Class 1a agent.
Diesel pyramid=Disopyramide
45
verapamil is examples of ?
Class 4 anti arrythmic
( Vipers on plane= with a large door=4)
46
Adverse of verapamil ?
Constipation
(Bathroom door is locked)
47
Class 1 B is examples ?
Lidocaine ( Cane using teacher who is lighting a ciggerate)
Class 1 B: 1st prize in spelling B
48
Drugs which are safe in AIP :
Hello Barbie , let’s take a sulphi and alcohol. I’ll take you out in Benz and give you OCP after sex.
Halothane
barbiturates
Sulphonamides
Alcohol
OCP
Benzodiazepines
49
Amiodarone S/E:
Corneal opacities
50
Amiodarone type 2: causes :
Destructive thyroiditis
Rx: Steroids
51
Amiodarone type 1 causes :
Ass with underlying thyroid disease
Rx: Antithyroid drugs
52
Amiodarone induced thyroitoxicosis Rx:
Steroids
53
Loss of vision is ass with Ethanol or methanol poisoning ?
Methanol poisoning
54
Dopamine receptor agonists:
Parkinson's disease
prolactinoma/galactorrhoea
cyclical breast disease
acromegaly
55
PCM OD pathophysiology :
Conjugation of paracetamol becomes saturated in overdose
56
Digoxin on QT interval ?
Shortening of QT interval
57
Inhibition of acetylcholine esterase causes ?
Increase in DMUBEL symptoms
58
ECG changes in Quinine toxicity ?
Prolonged QRS and Qt
59
Electrolyte imbalance in MDMA:
Hyponatremia
60
OP poisoning Rx:
IV Atropine
61
Heparin ( Enoxaparin ) S/E:
Thrombocytopenia ( Broken plates near door )
62
Drugs causing thrombocytopenia :
NSAIDS
Heparin
63
Aminoglycosides causes nephrotoxicity via ?
Tubular necrosis
64
Thiazides—Rash around face and neck , Due to :
Photosensitivity
65
Aspirin S/e:
Urticarial rash
66
Before increasing dose of metformin :
Leave at least one week before increasing
67
COCP is protective against :
Ovarian and endometrial cancer
68
Paracetamol overdose occurs when glutathione stores run-out leading to an increase in
NAPQI (N-acetyl-p-benzoquinone imine)
69
What is the mechanism of this treatment for PCM poisoning ?
Replenishes Glutathione.
70
In carbon monoxide poisoning, the oxygen dissociation curve :
Shift to the left and downwards
71
Psychiatric history + Confusion + coarse tremors :
Lithium Toxicity
72
Rifampicin MOA :
Inhibits RNA synthesis
73
Aminoglycosides MOA:
Inhibits 30 S ribosome—Inhibits protein synthesis.
74
Urticarial rash is caused by which blood thinner ?
Aspirin.
75
Drugs which precipitate Lithium Toxicity ?
DAMN
Diuretics—Thiazide diuretics
ACE/ARb
Metronidazole
NSAID.
76
Carbon monoxide poisoning - most common feature:
Headache
77
Drugs causing Impaired glucose Tolerance :
STATIN
Steroids
Thiazide
Antipsychotics
Tacrolimus
Interferon Alpha
Niacin.
78
Electrolyte Imbalance and side effects in cyclosporine :
Everything is Incresed.
Hyperkaleima
Hypertension
Glucose—Hyperglycaemia
Hair—Hisutism
Gums—Gingival hyperplasia
Nephrotoxcicty and hepatotoxicity
79
patients with an IgE medicated penicillin allergy will also be allergic to cephalosporins
Cephalosporin
80
Anti diabetic drug which causes ankle Edema and heart failure?
Pioglitazone
81
Agranulocytosis (low neutrophil)is caused by which anti epileptic ?
Carbamzapine.
82
Suicide attempts + Metabolic acidosis with High anion gap + No visual problem
Ethelyne glycol poisoning
83
Digoxin MOA :
Inhibits Na/K ATPase pump.
Used in rate control in Afib.
84
Common Adverse of Amitryptiline:
BPH
85
Most common antibiotic to cause urticaria ?
Penicillin
86
H/o Immunosupressive drugs + Morbiliform Extensive skin rash, fever and organ dysfunction (Liver , Kidneys, Hear , Lung) + Eosinophilia + DeRANGED LFTS(imp):
DRESS syndrome
87
Differentiate DRESS from Steven Johnson and TEN:
Dress: Morbiliform skin rash + deranged LFTs
Steven : Mucosal Involvement
TEN: desquamating skin lesion
88
UTI drug which causes Pulmonary Fibrosis:
Nitrofurantoin
89
In which poisoning ?
sinus tachycardia
widening of QRS
prolongation of QT interval
Tricyclic antidepressant Poisoning.
90
Fibrates Adverse :
Myopathy
91
most appropriate time to take blood samples for therapeutic monitoring of lithium levels?
12 hours after the last dose.
92
Drugs that can be cleared with haemodialysis - mnemonic
BLAST
Barbiturate
Lithium
Alcohol (inc methanol, ethylene glycol)
Salicylates
Theophyllines
93
the following adrenoceptors cause vasoconstriction and relaxation of GI muscle in response to sympathetic stimulation:
Alpha 1.
94
Which one of the following adrenoceptors causes inhibition of pre-synaptic neurotransmitter release in response to sympathetic stimulatio
Alpha 2
95
Which one of the following is a mixed alpha and beta adrenoceptor antagonist?
Carvedilol
96
Drugs causing thrombocytopenia :
Queen(quinindine) is playing abacus (abciximab) , had jerky syncope( anti seizures meds) and fell down, breaking down the plates= Decrease in platelets.
Queen= Qanada
Quinidine
Abciximan, anti convulsants
Antibiotics:Penicillin
NSAID
H- Heparin
97
Dopamine receptor agonist is used in :
Parkinson’s
Galactorhoea
Acromegaly
Neuroleptic malignant syndrome
Cyclical Breast disease.
98
Nevolumab MOA:
Nevo1umab= PD1 inhibitor
99
Ketamine MOA:
NMDA receptor Antagonist
100
Octreotide MOA:
Somatostatin Analogue
101
Metformin increases insulin sensitivity?
by activation of the AMP-activated protein kinase
102
Humanising:
decreases the immunogenicity of non-human derived monoclonal antibodies
103
Botox is therapeutically in ?
Achlasia
104
oculogyric crisis Rx:
Procyclidine/Benztropine
105
On Schizophrenia meds/Parkinsons + he develops a fixed stare. Shortly after, involuntary upward deviation of the eyes is noted.
Oculogyric crisis
106
Macrolides MOA:
Inhibits 50S ribosomes—inhibits protein synthesis
107
Most common side effects of metformin :
Diarrhoea
108
Which antibiotic to avoid in seizure patients ?
Ciprofloxacin lowers the seizure threshold
109
Cetuximab acts against ?
Epidermal Growth Factor
110
Heparin-induced thrombocytopaenia - antibodies form against
complexes of platelet factor 4 (PF4) and heparin
111
Visual problems in which anti tb drugs ?
Ethambutol—Causes Optic neuritis
112
Which Tb drug causes Peripheral Neuropathy ?
Isoniazid
113
Hydroxychloroquine:
Bull’s eye maculopathy
114
Yellow green vision is side effect o which drug ?
Digoxin
115
Digoxin toxicity is precipitated by ?
Thiazide diuretics
116
Metformin acts by activation of the AMP-activated protein kinase (AMPK)
AMP-activated protein kinase (AMPK)
117
Abciximab is :
glycoprotein IIb/IIIa receptor antagonist
118
Sulfonylureas(Chlorpropamide )
Hyponatremia
119
Infliximab
an anti-TNF monoclonal antibody
120
abdominal pain or rectal bleeding following cocaine ingestion(Mydriasis pupils, anxious, hypertensive)
Ischaemic colitis
121
Depolarising muscle relaxant :
Suxamethonium
122
Amiodarone—Develops Hypothyroidism. Rx?
Continue Amiodarone and add antithyroid drugs
123
Which anaemia does metformin cause ?
Vit B12
124
most appropriate time to take blood samples for therapeutic monitoring of ciclosporin levels?
Immediately before next dose.
125
Finasteride S/E:
Gyanaecomastia
126
Combined oral contraceptives absolute contraindication :
Women more than 35 years old and smoking more than 15 cigarettes/day
127
Anthracyclines S/E:
Cardiotoxicity
128
Heparin Induced thrombocytopenia is :
Thrombotic condition
129
Most common adverse effect in Progesterone only pill:
Irregular vaginal bleeding
130
In patients with renal impairment, monitoring the response to low molecular weight heparin
Anti-Factor Xa levels
131
Does TCA OD require dialysis ?
No
132
The constant region of the antibody is:
Human in origin
133
B1 agonist example:
Dobutamine
134
Tamsulosin:
Alpha 1A antagonist
135
Kawasaki disease :
IV Immunoglobulin
136
Heparin MOA:
Binds to Antithrombin 3—That inhibits factor 10 A
137
TCA OD , First line Rx:
IV Sodium Bicarbonate
138
Pilocarpine MOA :
Muscarinic receptor agonist.
Stimulates muscarinic cholinergic receptors to stimulate uveoscleral outflow
139
Rituximab MOA :
acts against CD20
140
Quinine toxicity ECG findings:
Prolonged QRS and QT interval
141
Which antibiotic is contraindicated in G6PD deficiency ?
Ciprofloxacin
142
Mechanism of N acetyl Cystine :
Replenishes Glutahione
143
Ciclosporin + tacrolimus:
Inhibits calcineurin thus decreasing IL-2.
144
On Metformin— Despite slowly titrating the dose up to 500mg tds he has experienced significant diarrhoea. Next step ?
Start Modified Release Metformin 500 Mg OD with evening meal.
145
Fomepizole MOA
inhibitor of alcohol dehydrogenase
146
which factor exacerbates Digoxin toxicity ?
Two hypers: Hypercalcemia, Hypernatremia.
Rest hypo: Hypokalemia
Hypomagnesemia
Hypothermia
Hypo QT interval—Short Qt interval in Digoxin
147
Blocked nose which drug is used and its MOA :
Phenylnephrine—Alpha 1 agonist
148
ECG findings in OP poisoning :
Sinus Bradycardia
149
Levothyroxine acts via which receptor ?
Nuclear receptor
150
Flouroquinolones MOA :
Inhibit bacterial DNA duplication through inhibition of topoisomerase
151
the most useful prognostic marker in paracetamol overdose?
Prothrombin Time
152
Does macrolides promote gastric emptying ?
Yes
153
Metformin and MI ?
Stop Metformin after MI during Lactic Acidosis
154
Oculogyric crisis is caused by ?
antipsychotics
metoclopramide
postencephalitic Parkinson's disease
155
Botox indication :
blepharospasm
hemifacial spasm
focal spasticity including cerebral palsy patients, hand and wrist disability associated with stroke
spasmodic torticollis
severe hyperhidrosis of the axillae
achalasia
156
Function of Sodium Bicarbonate in Lithium Toxicity :
Increasing the alkalinity of the urine promotes lithium excretion.
157
Which antibiotic to avoid with warfarin?
Marcrolides
158
Is hyperthermia a feature of cocaine ?
Yes
159
ECG in cocaine ?
QRS and QT prolongation
160
Why thirsty and passing more urine after alcohol ?
Ethanol suppresses ADH secretion
161
Pupils in cocaine ?
Mydriatic pupils
162
Patients receiving CHOP for non-Hodgkin's lymphoma, which drug to add ?
Allopurinol, as there is hyperuricaemia
163
Flecainide C/I :
Ischaemic heart disease.
Chronic heart failure
Chronic Hypertension
164
Statin in Pregnancy?
Contraindicated.
165
Octreotide in variceal Haemorrhage?
Yes can be used
166
Octreotide in VIPoma ?
can be used
167
M CAT is synonymous with
Ampehtamines
168
Antibiotics causing photosensitive rash:
Tetracyclines
169
TB drug causing Gout ?
Pyrizinamide
170
Allopurinol MOA :
Inhibits Xanthine oxidase
171
Tendinopathy : Adverse of which antibiotics ?
Fluorquinolones
172
If metformin is not tolerated due to GI side-effects, try a :
If metformin is not tolerated due to GI side-effects, try a modified-release formulation before switching to a second-line.
173
Trastuzumab (Herceptin) MOA
acts on the HER2/neu receptor
174
Does Metformin cause Kidney issues ?
It causes AKI
175
Does NSAID have nephrotoxicity ?
Yes
176
St John's Wort
known inducer of the P450 system
177
High anion Metabolic Acidosis—Think :
Anti freeze—ethelyne Glycol Poisoning
178
How is Ethambutol excreted ?
Excreted via Kidneys
179
Motion sickness Meds ?
Hyoscine > cyclizine > promethazine
180
Differentiate Methhaemoglobinaemia, Co Poisoning and Cyanide poisoning :
Methaemoglobinaemia: Normal pO2, low SpO2
CO poisoning: Low pO2, normal SpO2 (False normal SpO2 on Pulse oximeter)—Pulse ox confuses bw oxygen and Carbon Monoxide.
Cyanide poisoning: Normal pO2 and Normal SpO2 – Patient can have High Anion Gap Metabolic Acidosis + flushing (or 'brick red' skin)
181
Bleech consumption—unwell + Swallowing difficulty. Next step?
Urgent gastroduodenoscopy + Nil by mouth + Proton pump inhibitor
182
phase I drug metabolism?
Alcohol dehydrogenase
183
Sildenafil S/e :
visual disturbances
blue discolouration
non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism
184
Sildenafil C/I:
Nitrates and Nicorandil
185
Tamoxifen S/e :
Cardio toxicity and Hot Flushes
186
What takes place in Phase 2 ?
Conjugation
187
Blue vision is caused by which drug ?
Sildenafil
188
Sildenafil - MOA
phosphodiesterase type V inhibitor
189
First pass metabolism :
Love - heart drugs and Sex-testosterone
Aspirin
Isosorbde dinittrate
Glyceryl trinitrate
Propranolol
Verapamil
190
Hypomagnesemia ECG :
QT prolongation
191
Which Diurectics causes Hypomagnesemia ?
Furosemide
192
Hypomagnesemia causes :
TPN
Diarrhoea
Alcohol
Homeless drunk man drinking alcohol.
193
Mepolizumab MOA :
Anti IL5 Monoclonal Antibody—used in resistant asthma with high eosinophils
194
Omalizumab MOA :
Anti IgE Monoclonal Antibody—used in resistant asthma with raised igE and allergic symptoms
195
Asbestos chemotherapy Rx:
Pemetexed ( Antifolate: Inhibits DNA and RNA synthesis )
196
Idiopathic Pulmonary Fibrosis. Rx:
Ninetedanib.
197
Roflumilast :
PDE4 inhibitor.
Used in exacerbation of COPD
198
How does ACE inhibitor cause increase in creatinine level ?
Increase in Efferent renal Arteriolar Dilatation.
199
Long Qt syndrome cause ( Electrolyte imbalance cause ) :
Hypokalemia
Hypomagnesemia
Hypocalcemia
Harsha(Long Qt) ka lund chota hein(All Hypo causes)
200
Dobutamine MOA :
B1 agonist
DoButamine= B1 Agonist.
201
