Pharmacology

Question 1

Aminoglycoside AE

Answer 1

Ototoxicity, renal toxicity

Question 2

Statin AE

Answer 2

Rhabdomyolysis - raised CK and AKI, muscle pain

Question 3

Clozapine, carbamazepine, sulfasalazine AE

Answer 3

Agranulocytosis

Question 4

Drugs causing gastric ulcers

Answer 4

NSAIDs, steroids, SSRIs, alendronic acid

Question 5

Statin counselling

Answer 5

Statins are a drug that reduce the amount of cholesterol in your blood. Too much cholesterol can sit in your arteries and lead to heart disease, renal disease and strokes.

Tablet is taken once a day in the evening before bed

• Atorvastatin 20mg for primary prevention
• Atorvastatin 80mg for secondary prevention
• can cause rhabdomyolysis
• if get muscle pain check CK - if 5x upper limit or normal stop

You won’t see any noticeable benefit from the statin however it is really important you take it every day as it is working away in the background to make you better

Side effects can include muscle pain, abdo pain, nausea, hair loss, itching, nose bleeds

Can cause rhabdomyolysis

We will check your liver function before you start statins then at 3m and 12m. Also routinely check lipid levels

Not take if pregnant, avoid grapefruit

Question 6

How to take bisphosphonate

Answer 6

Take once a week in the morning at least 30 mins before food with plenty of water. Important to sit straight or stand for 30 minutes after

Question 7

Statins are stopped when giving what Abx?

Answer 7

Macrolides e.g. azithromycin, clarithromycin and erythromycin

Question 8

Anticholinergic SE + what drugs cause them

Answer 8

Peripheral - dry mouth, dry skin, constipation, reduced urine frequency, blurred vision, photophobia, dilated pupil, tachycardia, hypertension

Central - Delirium, agitation, disorientation, ataxia, unwanted movements, seizure

Antispasmodics e.g. hyoscine butylbromide
Antidepressant - amitriptyline
Anti parkinosnium - Amantadine
Antihistamine - loratadine
Antiemetic - cyclizine, metoclopramide
Antipsychotics - onlanzapine, chlorpromazine

Question 9

Main SEs of metformin

Answer 9

Lactic acidosis, GI upset, decreased B12 absorption

Question 10

What diabetes drug causes hypo and weight gain

Answer 10

Sulphonylureas

- take in morning to prevent nocturnal hypo

Question 11

Main SE/ consequence of methotrexate use?

Answer 11

Pulmonary fibrosis

Question 12

Consequences of sulfasalazine use?

Answer 12

Agranulocytosis and male infertility

Question 13

Warfarin counselling

Answer 13

Warfarin is a blood thinner that helps stop clots from blocking blood vessels within the body. It does this by blocking the function of vitamin K

It is taken once a day in the tablet form
If you miss a dose for any reason then just take the same single tablet the next day. Do not double dose

Takes 2-3 days to begin working, on these days re given a higher loading dose
Monitor INR - aim for 2-3, write in yellow book

take 3m for DVT
take 6m for PE
Lifelong AF
Wear warfarin alert bracelet

Seek medical help if GI bleed, Epistaxis, trauma, cuts that won’t stop. Can cause diarrhoea, rash, hair loss, nausea.
Warn surgeons

Can interact with medications including over the counter like St johns wart - read information leaflet
Avoid foods high in Vit K including liver, spinach, cranberry. Avoid alcohol binges. Avoid contact sports.

Carry around an anticoagulant card

Contraindicated in pregnancy, if at high risk of falls

Question 14

What condition are beta blockers contraindicated in

Answer 14

Severe asthma

Question 15

Drugs that increase risk of gastric ulcers

Answer 15

NSAID, bisphosphonate, SSRI, corticosteroids, cocaine, K+ supplements

Question 16

Drugs that relax upper oesophageal sphincter and therefore increase GORD

Answer 16

CCBs, Anticholinergics, benzodiazepines, nitrates, theophylline