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Pharmacology Flashcards

1
Q

What is oral allergy syndrome?

A

IgE mediated hypersensitivity to specific plant based foods

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2
Q

Test for food allergies and pollen

A

Skin prick testing

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3
Q

Test for contact dermatitis

A

Skin patch testing

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4
Q

Test for food allergies, inhaled allergens like pollen, and venom

A

RAST

Radioallergosorbent test

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5
Q

How does RAST testing work?

A

Determines amount of IgE that reacts specifically with suspected or known allergen

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6
Q

Anaphylaxis dose of adrenaline age <6 months

A

150 micrograms

0.15ml of 1 in 1000

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7
Q

Anaphylaxis dose of hydrocortisone <6 months

A

25mg

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8
Q

Anaphylaxis dose of chlorphenamine <6 months

A

250 microgram per kg

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9
Q

Anaphylaxis dose of adrenaline 6 months till 6 years

A

150 micrograms

0.15ml of 1 in 1000

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10
Q

Anaphylaxis dose of hydrocortisone 6 months till 6 years

A

50mg

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11
Q

Anaphylaxis dose of chlorphenamine 6 months till 6 years

A

2.5mg

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12
Q

Anaphylaxis dose of adrenaline 6 to 12 years

A

300 micrograms

0.3ml of 1 in 1000

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13
Q

Anaphylaxis dose of hydrocortisone 6 to 12 years

A

100mg

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14
Q

Anaphylaxis dose of chlorphenamine 6 to 12 years

A

5mg

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15
Q

Anaphylaxis dose of adrenaline >12 years

A

500 micrograms

0.5ml of 1 in 1000

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16
Q

Anaphylaxis dose of hydrocortisone >12 years

A

200mg

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17
Q

Anaphylaxis dose of chlorphenamine >12 years

A

10mg

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18
Q

What causes oral allergy syndrome?

A

cross-reaction with a non-food allergen most commonly birch pollen

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19
Q

What is the starting dose of oral morphine for a palliative patient?

A

20-30mg MR per day

5mg for break through

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20
Q

What is the breakthrough dose of morphine?

A

1/6th the daily dose of morphine

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21
Q

Options for analgesia in palliative patients with mild to moderate renal impairment

A

oxycodone

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22
Q

Options for analgesia in palliative patients with severe renal impairment

A

alfentanil
buprenorphine
fentanyl

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23
Q

What percentage should you increase the dose of opioids by in palliative patients?

A

30-50%

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24
Q

How to convert oral codeine to oral morphine

A

Divide by 10

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25
How to convert oral tramadol to oral morphine
Divide by 10
26
How to convert oral morphine to oral oxycodone
Divide by 1.5 to 2
27
What are the differences in side effects between oxycodone and morphine?
Oxycodone has less sedation, vomiting and pruritis but more constipation
28
What does a 12 microgram transdermal fentanyl patch equate to in oral morphine?
30mg oral morphine
29
What does a transdermal buprenorphine 10 microgram patch equate to in oral morphine?
24mg oral morphine
30
How to convert oral morphine to subcutaneous morphine
Divide by 2
31
How to convert oral morphine to subcutaneous diamorphine
Divide by 3
32
How to convert oral oxycodone to subcutaneous diamorphine
Divide by 1.5
33
Medications that cause postural hypotension
``` Nitrates Diuretics Anticholinergics Antidepressants Beta blockers L-Dopa ACE inhibitors ```
34
Palliative care management of agitation and confusion 1st line, 2nd line and terminal phase
1st line = haloperidol 2nd line = chlorpromazine, levomepromazine Terminal phase = midazolam
35
Treatment of nausea due to reduced gastric motility
Metoclopramide
36
Treatment of nausea which is chemically mediated
Ondansetron Haloperidol Levomepromazine
37
Treatment of nausea which is due to raised intracranial pressure
Cyclizine | Dexamethasone
38
Treatment of nausea due to vestibular system
Cyclizine
39
Management of hiccups in palliative care 1st line and 2nd line
Chlorpromazine 2nd line = haloperidol, gabapentin, dexamethasone
40
Schedule 1 drugs
Cannabis | Lysergide (LSD)
41
Schedule 2 drugs
``` Diamorphine Morphine Pethidine Amphetamine Cocaine ```
42
Schedule 3 drugs
Barbituates buprenorphine midazolam temazepam tramadol gabapentin pregabalin
43
Schedule 4 drugs
Benzodiazepines, zolpidem, zopiclone Androgeneric and anabolic steroids, hCG, somatrophin
44
Schedule 5 drugs
Codeine Pholcodine Oramorph
45
Drug interactions with amiodarone
Decreases metabolism of warfarin (so increased INR) Increased digoxin levels
46
Side effects of amiodarone
``` Thyroid dysfunction Corneal deposits Pulmonary fibrosis Liver fibrosis, hepatitis Peripheral neuropathy Photosensitivity Slate grey appearance Bradycardia Lengthens QT interval ```
47
What percentage of delayed prescribing scripts are used?
32%
48
What extra information do children need on their prescription?
Their age until age 12
49
Examples of quinolone antibiotics
Ciprofloxacin | Levofloxacin
50
What type of antibiotic is ciprofloxacin?
Quinolone
51
What type of antibiotic is levofloxacin?
Quinolone
52
Adverse effects of quinolone antibiotics
Lower seizure threshold in epilepsy Tendon damage and rupture Lengths QT interval
53
Contraindications for quinolone antibiotics
Pregnant or breastfeeding | Avoid in G6PD
54
Examples of macrolide antibiotics
Erythromycin Clarithromycin Azithromycin
55
Adverse effects of macrolides
``` Prolonged QT interval GI side effects Cholestatic jaundice P450 inhibitor (stop statins) ``` Azithromycin is associated with hearing loss and tinnitus
56
Which antibiotics associated with hearing loss?
Gentamicin | Azithromycin
57
Vitamin supplementation in alcoholics
Oral thiamine
58
Drugs used in alcoholism
Disulfram - promotes abstinence Acamprosate - reduces alcohol cravings
59
Which drug reduces alcohol cravings?
Acamprosate
60
Which drug causes severe reaction when alcohol is drank to promote abstinence?
Disulfram
61
Contraindications to disulfram
Ischaemic heart disease | Psychosis
62
What are the benefits of HRT for premature menopause?
Reduces cardiovascular disease Reduces osteoporosis Reduces risk of cognitive impairment
63
Which patients should not get mefloquine?
Any psychiatric history It is an antimalarial
64
Common side effects of metformin
GI side effects | Lactic acidosis
65
Common side effects of sulfonylureas
Hypoglycaemic episodes Increased appetite, weight gain SIADH Cholestatic liver dysfunction
66
Common side effects wih glitazones
Weight gain Fluid retention Liver dysfunction Fractures
67
Common side effects with gliptins
Pancreatitis
68
Drugs that must be stopped in pregnancy (not including antibiotics)
``` ACE I, ARBs Statins Warfarin Sulfonylureas Retinoids (including topical) Cytotoxic agents ```
69
Antibiotics that must not be used during pregnancy
Tetracyclines Aminoglycosides Sulphonamides Trimethoprim
70
How long after MI can you prescribe sildenafil?
6 months
71
Side effects of sildenafil
``` Blue discolouration of vsion Nasal congestion Flushing GI side effects Headache Priapism ```
72
Drugs to avoid in renal failure
Tetracyclines Nitrofurantoin NSAIDs Lithium Metformin
73
Drug causes of urticaria
Aspirin Penicillin NSAIDs Opiates
74
What are alpha blockers used for?
BPH | HTN
75
Examples of alpha blockers
Doxazosin | Tamsulosin
76
What type of drug is doxazosin?
Alpha blocker
77
What type of drug is tamsulosin?
Alpha blocker
78
Side effects of alpha blockers
Postural hypotension Drowsiness Dyspnoea Cough
79
Monitoring for patients on statins
LFTs at baseline, 3 months and 12 months
80
Monitoring for patients on ACE-I
U+E prior to treatment, after increasing dose, and annually
81
Monitoring for patients on amiodarone
TFT, LFT, U+E, CXR prior to treatment TFT and LFT every 6 months
82
Monitoring for patients on methotrexate
FBC, LFT, U+E before starting treatment and then weekly until stable Once stable every 2-3 months
83
Monitoring for patients on azathioprine
FBC, LFT before treatment FBC weekly for the first 4 weeks FBC, LFT every 3 months
84
Monitoring for patients on lithium
TFT, U+E prior to treatment Lithium levels weekly until stabilised TFT, U+E every 6 months
85
Monitoring for patients on sodium valproate
LFT, FBC before treatment LFT periodically in first 6 months
86
Monitoring for patients on glitazones
LFT before treatment | LFT 'regularly' during treatment
87
Contraindications to sildenafil
``` Nitrates Nicorandil MI or stroke in the last 6 months Hypotension Need to avoid alpha blockers for 4 hours after sildenafil ```
88
Which drugs should be prescribed by brand?
``` CCB Anti-epileptics Ciclosporin and tacrolimus Mesalazine Lithium Aminophylline and theophyline Methylphenidate CFC free beclometasone Dry power inhaler devices ```
89
Diclofenac contraindications
Ischaemic heart disease Peripheral arterial disease Cerebrovascular disease Congestive heart failure class II-IV
90
Which NSAIDs can be used in patients with cardiovascular disease?
Naproxen Low dose ibuprofen Diclofenac is contraindicated
91
Which vaccines should be given to pregnant women?
Pertussis and influenza
92
Drug causes of hypomagnesaemia
PPIs Diuretics Alcohol
93
Side effects of tamoxifen
Menstrual disturbance Hot flushes Venous thromboembolism Endometrial cancer
94
Drugs contraindicated in heart failure
``` Pioglitazone Verapamil NSAIDs Glucocorticoids Flecainide ```
95
P450 inducers
BS CRAP GPS ``` Barbituates St Johns wart Carbamazepine Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbitone Sulfonureas ```
96
P450 inhibitors
SICK FACES ``` Sodium valproate Isoniazid Ciprofloxacin Ketoconazole Fluoxetine Allopurinol / Amiodarone Cimetidine / Omeprazole Erythromycin / Clarithromycin Sertraline ```
97
When to take digoxin level?
6-12 hours post dose
98
When to take lithium level?
12 hours post dose
99
When to take ciclosporin level?
Trough level immediately before dose
100
What determines if a women gets sequential or continuous combined HRT?
If had period within the last 12 months then sequential If no period in the last 12 months then combined
101
Causes of oculogyric crisis
Antipsychotics Metoclopramide Post-encephalitic Parkinson's disease
102
Management of oculogyric crisis
IV benztropine or procyclidine
103
Which drugs precipitate lithium toxicity?
Diuretics - especially thiazides ACE-I ARBs NSAIDS Metronidazole
104
Features of lithium toxicity
``` Coarse tremor Hyperreflexia Acute confusion Polyuria Seizure Coma ```
105
Management of lithium toxicity
IV saline | Haemodialysis
106
Drugs that worsen seizure control in epilepsy
Alcohol, cocaine, amphetamines Ciprofloxacin, levofloxacin Aminophylline, theophylline Methylphenidate Mefenamic acid
107
Drug causes of impaired glucose tolerance
``` Thiazides, furosemide Steroids Tacrolimus, ciclosporin Interferon-alpha Nicotinic acid Antipsychotics ```
108
1st line management for motion sickness
Hyoscine transdermal patch
109
2nd line management for motion sickness
Cyclizine
110
3rd line management for motion sickness
Promethazine
111
What is the main cause of digoxin toxicity?
Hypokalaemia
112
Side effects of ciclosporin
Everything is increased - fluid, BP, K+, hair, gums, glucose
113
Side effects of finasteride
Impotence Decreased libido Ejaculation disorders Gynaecomastia and breast tenderness
114
Features of organophosphate insecticide poisoning
``` Salivation Lacrimation Urination Defecation/diarrhoea Hypotension, bradycardia Small pupils, muscle fasciulation ```
115
Management of organophosphate poisoning
Atropine
116
Which scoring system is used to assess bleeding risk before starting a NOAC?
ORBIT score
117
How long must a patient eat gluten for prior to coeliac testing?
6 weeks
118
Drugs that can cause drug-induced thrombocytopenia
``` Quinine Abciximab NSAIDs Furosemide Penicillin, sulphonamides, rifampicin Carbamazepine, valproate Heparin ```
119
Adrenaline dose for adults in anaphylaxis
0.5mg of 1 in 1,000 IM
120
Adrenaline dose for adults in cardiac arrest
10ml of 1 in 10,000 IM
121
Drug causes of gynaecomastia
Spironolactone Cimetidine Digoxin
122
Features of ecstasy poisoning
``` Agitation, anxiety, ataxia Tachycardia, hypertension Hyponatraemia Hyperthermia Rhabdomyolysis ```
123
Most characteristic side effect of co-amoxiclav
Cholestasis
124
Most characteristic side effect of flucloxacillin
Cholestasis several weeks after use
125
Most characteristic side effect of erythromycin
GI upset | QT interval prolongation
126
Most characteristic side effect of ciprofloxacin
Lowers seizure threshold | Tenonitis
127
Most characteristic side effect of doxycycline
Photosensitivity
128
Most characteristic side effect of trimethoprim
Rashes, including photosensitivity Pruritis Suppression of haematopoiesis
129
Causes of neuroleptic malignant syndrome
Antipsychotics - within hours or days Parkinson's meds - when suddenly stopped
130
Features of neuroleptic malignant syndrome
Pyrexia Muscle rigidity HTN, tachycardia, tachypnoea Agitation, confusion
131
Investigations in neuroleptic malignant syndrome
Raised CK | May cause AKI
132
Management of neuroleptic malignant syndrome
Stop antipsychotic IV fluids Dantrolene
133
Features of serotonin syndrome
Hyperreflexia, myoclonus, rigidity Hyperthermia Sweating Confusion
134
Management of serotonin syndrome
IV fluids | Benzodiazepines
135
Side effects of metformin
DOES NOT cause hypoglycaemia or weight gain GI upset Lactic acidosis if severe illness
136
Uses for metformin
1st line T2DM PCOS NAFLD
137
Contraindications to metformin
Review dose if egfr <45 or cr >130 Stop if egfr <30 or cr >150 Stop if having contrast scan on day of scan, restart after 48 hours Alcohol abuse
138
Adverse effects of St Johns wort
Same side effects as placebo Serotonin syndrome Inducer of P450
139
Most common precipitant of digoxin toxicity
Hypokalaemia
140
Features of digoxin toxicity
Unwell, N+V, confusion Yellow-green vision Arrhythmia Gynaecomastia
141
Management of digoxin toxicity
Digibind

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