pharmacology Flashcards
features of digoxin toxicity
generally unwell - lethargy, N&V, anorexia and confusion
yellow-green tinted vision
arrhythmia (AV block, bradycardia)
drugs which may precipitate digoxin toxicity
Amiodarone
Verapamil
Diltiazem
Any drug that causes hypokalaemia - thiazides and loop diuretics
features of cocaine use
coronary artery spasm (-> MI) seizures dilated pupils (mydriasis) agitation and psychosis ischaemic colitis can occur leading to vomiting
most useful prognostic marker in paracetamol OD
prothrombin time
ABG in salicylate overdose
respiratory alkalosis then metabolic acidosis
which medication should be used in DVT with reduced renal function
eGFR >15 - DOAC
eGFR <15 - unfractionated heparin or dose-adjusted LWMH
blood test to do before starting PO terbinafine
LFTs
in which conditions should thiazide-like diuretics be avoided
gout
what medications can cause black hairy tongue
tetracyclines
what should be done if INR is too low on warfarin
increase dose of warfarin and start LWMH for immediate anticoagulation
stop LWMH when INR is normal
general management for any ingested overdose
activated charcoal if they present within 1 hour of ingestion
reversal agent for magnesium sulphate induced respiratory depression
calcium gluconate
moa of statins
inhibit action of HMG-CoA reductase thereby decreasing intrinsic cholesterol synthesis
adverse effects of loop diuretics
hyponatraemia, hypokalaemia, hypomagnesaemia
hypocalcaemia (hence fractures)
ototoxicity
gout
which ABX must be avoided with alcohol
metronidazole
met = traffic, don’t drink and drive
SE of anticholinergics
dry mouth constipation urinary retention impaired cognition falls
features of lithium toxicity
confusion *coarse tremor* jerking limb movements polyuria hyperreflexia
reversal agent in acute dystonia due to antiemetics (e.g. metoclopramide)
benztropine or procyclidine
which ABX inhibit protein synthesis
macrolides
tetracyclines
aminoglycosides
chloramphenicol
mx of lithium overdose
mild-moderate: fluid resus
severe: haemodialysis
features of tricyclic antidepressant overdose
early features - anticholinergic properties (dry mouth, dilated pupils, blurred vision, agitation)
later - seizures, arrhythmias, metabolic acidosis
features of ecstasy overdose
serotonin syndrome - altered mental state, hyperthermia, pupil dilation
increased reflexes
criteria for liver transplant in paracetamol overdose
arterial pH <7.3, 24h after ingestion or all of: PT >100s creatinine >300 grade III or IV encephalopathy
monitoring for Warfarin
E on its side = W = Warfarin
PeTT = PT (prothrombin time)
pEtt = Extrinsic pathway
monitoring for Heparin
TT together = H = Heparin
APiTT = APTT (activated prothrombin time)
apItt = Intrinsic pathway
monitoring for LMWH
anti-factor Xa levels
important cause of drug-induced thrombocytopenia
heparin
mx of paracetamol OD
activated charcoal if within 1 hour of overdose
N-acetylcysteine if indicated by paracetamol levels
if staggered OD N-acetylcysteine immediately
diabetic med to avoid in eGFR <30
metformin
dose of adrenaline in cardiac arrest
1mg
10 ml 1:10,00 IV
dose of adrenaline in anaphylaxis
- 5 mg
0. 5 ml 1:1,000 IM
mx of tricyclic overdose
IV bicarbonate if hypotension or arrhythmia (wide QTS >100msec or ventricular arrhythmia)
features of LSD intoxication
colourful visual hallucinations
depersonalisation
psychosis
paranoia
mx of LSD intoxication
lorazepam
complications of opioid misuse
HIV, hep B, hep C from needle sharing
VTE
overdose -> resp depression + death
drugs to avoid in renal failure (CKD)
most ABX digoxin methotrexate furosemide opioids
drugs safe in renal failure
erythromycin
rifampicin
warfarin
diazepam
monitoring when on methotrexate
FBC, LFT and U&Es
monitoring before starting amiodarone and then when on amiodarone
before - TFT + LFT + U&E + CXR
on - TFT and LFT
groups of patients at increased risk of developing hepatotoxicity in paracetamol OD
patients taking liver enzyme-inducing drugs
malnourished patients
how to decide which HRT to give
1. womb or no womb womb = combined no = oestrogen only 2. last LMP <1 year ago = cyclical >1 year ago = continuous
mx of organophosphate poisoning
atropine
precipitants of lithium toxicity
dehydration diuretics (especially thiazides) ACEi/ARBs NSAIDs metronidazole
underlying immunology of anaphylactoid reactions
what med is this common in
non-IgE mediated mast cell release, commonly seen in N-Acetylcysteine
ciclosporin adverse effects
everything increased
hepatotoxicity and nephrotoxicity
ix before giving flecainide
echocardiogram
mx of hypomagnesaemia
IV Mg if <0.4 mmol/l or tetany, arrhythmias or seizures
PO Mg if >0.4mmol/l
amiloride
potassium-sparing diuretic
should not be co-prescribed w spironolactone
drugs causing urinary retention
TCAs
anticholinergics
opioids
NSAIDs
what to do in heparin-induced thrombocytopenia
swap to direct thrombin inhibitor, e.g. argatroban and bivalirudin
receptor that metaclopramide works on
dopamine antagonist
side effects of sildenafil (viagra)
blue discolouration of vision
headaches
flushing
ABX to avoid in G6PD
quinolone, e.g. ciprofloxacin
drugs to avoid if a person is on a statin
erythromycin and clarithromycin
taking these together can lead to statin-induced myopathy
what should be measured if suspecting carbon monoxide poisoning
carboxyhemoglobin
target oxygen concentration in carbon monoxide poisoning
100%
features of carbon monoxide poisoning
headache
N&V
vertigo
confusion
mx of ethylene glycol toxicity (anti-freeze)
fomepizole
ethanol/haemodialysis
ABG findings in ethylene glycol toxicity
metabolic acidosis w high anion gap and high osmolar gap
how may heparin-induced thrombocytopenia present
presents after 5-10 days of treatment
prothrombotic condition therefore DVT can occur
