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MRCP > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Which drugs are affected by acetylator status

A 
Isoniazid
Procainamide
Hydralazine 
Dapsone
Sulfasalazine
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2
Q

What are the features of Ach accumulation seen in organophosphate poisoning and sarin gas

A 
Salivation
Lacrimation
Urination
Defecation/diarrhoea
Cardiovascular: hypotension, bradycardia
Small pupils, muscle fasciculations
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3
Q

What causes heparin induced thrombocytopenia

A

Antibodies form against complexes of platelet factor 4 and heparin

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4
Q

Which drugs can be cleared by haemodialysis

A

BLAST

Barbiturates, lithium, alcohol, salicylates, theophyllines

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5
Q

Which drugs have significant first pass metabolism

A

Aspirin, ISDN, GTN, lignocaine, propranolol, verapamil, isoprenaline, testosterone, hydrocortisone

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6
Q

Which drugs exhibit zero order kinetics

A

Phenytoin, high dose aspirin, heparin, ethanol

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7
Q

When is best time to check phenytoin and ciclosporin levels

A

Immediately before next dose

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8
Q

When is best to check lithium levels

A

12 hrs post dose

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9
Q

When is best to check digoxin levels

A

6 hrs post dose

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10
Q

Which drugs commonly cause urticaria

A

Aspirin
Penicillins
NSAIDs
Opiates

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11
Q

Which drug can cause yellow tinting of vision

A

Digoxin

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12
Q

Which drug can cause blue tinting of vision

A

Sildenafil

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13
Q

What is the MOA of digoxin

A

Decreases conduction through AV node, increases force of contraction due to inhibition of Na/K+ ATPase pump

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14
Q

Which electrolyte abnormality classically causes digoxin toxicity

A

Hypokalaemia (digoxin binds to same same on ATPase pump as K+)

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15
Q

What are the indications for hyperbaric oxygen in CO poisoning

A

Carboxyhaemoglobin concentration >25%, LOC, neurology, MI/arrhythmia, pregnancy

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16
Q

What are the adverse effects of ciclosporin

A

Nephrotoxicity, hepatotoxicity, fluid retention, hypertension, hyperkalaemia, hypertrichosis, gingival hyperplasia, tremor, impaired glucose tolerance, hyperlipidaemia

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17
Q

What is the strongest indication for liver transplant after paracetamol overdose

A

Arterial pH <7.3, 24hrs after ingestion

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18
Q

What is the best action if metformin is not tolerated due to side effects

A

Try MR formulation of metformin

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19
Q

What are the causes of low magnesium

A

Diuretics, PPIs, TPN, diarrhoea, alcohol, hypokalaemia, hypercalcaemia, gitleman’s, bartter’s

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20
Q

Which drugs interact with allopurinol

A

Azathioprine, cyclophosphamide, theophylline

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21
Q

Which CCB can cause constipation

A

Verapamil

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22
Q

What is the MOA of aspirin

A

Non-reversible COX1 and 2 inhibitor

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23
Q

Which drugs cause corneal opacities

A

Amiodarone, indomethacin

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24
Q

Which drugs cause optic neuritis

A

Ethambutol, amiodarone, metronidazole

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25
Q

Which drugs cause impaired glucose tolerance

A

Thiazides, furosemide, steroids, tacrolimus, ciclosporin, interferon-alpha, nicotinic acid, antipsychotics

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26
Q

What is the MOA of phenytoin

A

Binds to sodium channels to increase their refractory period

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27
Q

What are the acute adverse effects of phenytoin

A

Dizziness, diplopia, nystagmus, slurred speech, ataxia

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28
Q

What are the chronic adverse effects of phenytoin

A

Gingival hyperplasia, hirsutism, coarsening of facial features, megaloblastic anaemia, peripheral neuropathy, osteomalacia, lymphadenopathy, dyskinesia

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29
Q

What is the MOA of infliximab

A

Anti-TNF

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30
Q

What is the MOA of cetuximab

A

EGFR antagonist

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31
Q

What is the MOA of alemtuzumab

A

Anti-CD52

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32
Q

What is the MOA of abciximab

A

Glycoprotein IIb/IIIa receptor antagonist

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33
Q

Which P450 subtype breaks down warfarin

A

CYP2C9

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34
Q

Which P450 subtype breaks down alcohol

A

CYP2E1

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35
Q

Which antibiotic can precipitate lithium toxicity

A

Metronidazole

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36
Q

What is the MOA of disulfiram

A

Inhibits acetaldehyde dehydrogenase- unpleasant side effects

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37
Q

What is the MOA of acamprosate

A

NMDA antagonist - reduces craving

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38
Q

Which poisoning causes widespread deposits of calcium oxalate crystals

A

Ethylene glycol

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39
Q

What is the treatment of ethylene glycol toxicity

A

Fomepizole/ethanol - competitive inhibitor for alcohol dehydrogenase

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40
Q

Which poisoning seen in a middle aged homeless man causes snow field cataracts

A

Methanol poisoning

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41
Q

Which drug has the highest chance of smoking cessation

A

Bupropion

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42
Q

What is the MOA of varencycline

A

Nicotinic agonist

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43
Q

What is the MOA of bupropion

A

NE and dopamine reuptake inhibitor, nicotinic antagonist

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44
Q

Which smoking cessation therapy should be avoided in epilepsy

A

Bupropion

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45
Q

Which poisoning causes brick red skin and smelling of bitter almonds

A

Cyanide

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46
Q

What is the treatment of cyanide poisoning

A

IV hydroxocobalamin or IV dicobalt edetate

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47
Q

What are malathion and parathion

A

Organophosphate insecticides

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48
Q

What is the treatment of acetylcholinesterase inhibition poisoning (organophosphate/nerve gas)

A

IV atropine, pralidoxime

Remove clothes, wash contaminated areas

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49
Q

Which poisoning causes pink/cherry red skin and confusion

A

Carbon monoxide

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50
Q

Which poisoning causes mixed sensorimotor polyneuropathy and Mee’s lines on finger nails

A

Arsenic poisoning (pesticides)

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51
Q

Which poisoning causes type 4 RTA and basophilic stippling of RBCs

A

Lead poisoning

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52
Q

What blood lead level is diagnostic

A

> 10

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53
Q

What are the symptoms/signs of lead poisoning

A

Motor neuropathy, blue lines on gum margins

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54
Q

What is the treatment of lead poisoning

A

Dimercaprol (DMSA), calcium edetate

55
Q

Which interferons bind to type 1 receptors

A

INF-alpha, INF-beta

56
Q

Which cells produce INF-alpha

A

Leukocytes

57
Q

Which cells produce INF-beta

A

Fibroblasts

58
Q

Which cells produce INF-gamma

A

T lymphocytes and NK cells

59
Q

What condition is INF-beta used in

A

Relapsing-remitting MS

60
Q

What conditions are INF-gamma used in

A

Chronic granulomatous disease, osteopetrosis

61
Q

What conditions are INF-alpha used in

A

HBV, HCV, Kaposi’s sarcoma, metastatic renal Ca, hairy cell leukaemia

62
Q

Which drugs can cause sensorineural deafness

A

IV furosemide, IV vancomycin, IV erythromycin

63
Q

What is the treatment of severe serotonin syndrome

A

Cyproheptadine

64
Q

What is the treatment of neuroleptic malignant syndrome

A

Bromocriptine

65
Q

Where does levothyroxine act

A

Nuclear receptors

66
Q

What are the side effects of lithium

A

Goitre/hypothyroidism, fine tremor, weight gain, diarrhoea, T wave flattening/inversion, nephrogenic diabetes insipidus, hypercalcaemia, hypermagnasaemia

67
Q

Which drugs cause a photosensitive rash

A

Amiodarone, thiazides, NSAIDs, sulphonylureas, tetracyclines, sulphonamides, ciprofloxacin, psoralen, ACEi/ARB

68
Q

What are the causes of gingival hyperplasia

A

Phenytoin, cyclosporin, nifedipine, AML

69
Q

What do Beta-3 adrenoreceptors cause

A

Lipolysis

70
Q

Which adrenoreceptor inhibits adenylate cyclase

A

Alpha-2

n.b. All beta receptors stimulate adenylate cyclase

71
Q

What class of drug is phenylephrine

A

Alpha-1 agonist

72
Q

What class of drug is dobutamine

A

Beta-1 agonist

73
Q

What class of drug is clonidine

A

Alpha-2 agonist

74
Q

When should sodium bicarbonate be given in TCA overdose

A

PH <7.1, QRS >160, arrhythmias, hypotension

75
Q

What adverse effect is common with trastuzumab

A

Cardiotoxicity - echo before starting

76
Q

Which TB drug needs dose-adjusting in renal failure

A

Ethambutol

77
Q

Which antibiotic is contra-indicated in G6PD deficiency

A

Ciprofloxacin

78
Q

Which antibiotics reduced the efficacy of the COCP

A

Only enzyme-inducing antibiotics e.g. rifampicin

79
Q

Which poisoning leads to mixed respiratory alkalosis and metabolic acidosis

A

Salicylate poisoning

80
Q

What concentration of salicylate is an indication for haemodialysis in overdose

A

> 700

81
Q

What causes aminoglycoside nephrotoxicity

A

Acute tubular necrosis

82
Q

When is haemodialysis indicated in lithium toxicity

A

Conc >2 with neuro symptoms or renal failure

83
Q

What is the MOA of metformin

A

Activates the AMP-activated protein kinase (AMPK), increases insulin sensitivity, decreases hepatic gluconeogenesis

84
Q

When should gentamicin doses be checked

A

Peak (1hr after administration) and trough (just before next dose)

85
Q

What should be adjusted if the peak level of gentamicin is too high

A

Decrease dose

86
Q

What should be adjusted if the trough level of gentamicin is too high

A

Increase interval between doses

87
Q

What is the most common adverse effect of the progesterone-only pill

A

Irregular vaginal bleeding

88
Q

Which anti-anginal can cause anal ulceration

A

Nicorandil

89
Q

What is the MOA of ketamine

A

NMDA receptor antagonist

90
Q

What is the MOA of propofol

A

GABA receptor agonist

91
Q

Which TCAs are most dangerous in overdose

A

Amitriptyline, dosulepin

92
Q

Which anti-glycaemic drug is contraindicated in history of bladder cancer

A

TZDs (pioglitazone)

93
Q

What is the pathophysiology of amiodarone-induced thyrotoxicosis type 1

A

Excess iodine-induced thyroid hormone synthesis

94
Q

What is the pathophysiology of amiodarone-induced thyrotoxicosis type 2

A

Amiodarone-related destructive thyroiditis

95
Q

Which amiodarone-induced thyrotoxicosis presents with goitre

A

AIT type 1

96
Q

What is the treatment of amiodarone-induced thyrotoxicosis type 1

A

Carbimazole

97
Q

What is the treatment of amiodarone-induced thyrotoxicosis type 2

A

Corticosteroids

98
Q

What causes amiodarone-induced hypothyroidism

A

High iodine content of amiodarone - Wolf-Chaikoff effect

99
Q

When can amiodarone be continued in amiodarone-related thyroid disease

A

Amiodarone-induced hypothyroidism (not -induced thyrotoxicosis)

100
Q

What is the treatment of symptomatic caustic ingestion

A

High dose IV PPI and urgent endoscopy

101
Q

Which antibiotic is teratogenic leading to grey baby syndrome

A

Chloramphenicol

102
Q

What can smoking and cocaine cause during pregnancy

A

Preterm labour

103
Q

What class of drug is tamsulosin

A

Alpha-1a antagonist (mainly acts on urogenital tract)

104
Q

What are nivolumab and ipilimumab used to treat

A

Metastatic melanoma

105
Q

What are the other drugs that are enzyme inhibitors not included in AO DEVICES

A

Cimetidine, amiodarone, ketoconazole, fluconazole, fluoxetine, sertraline, ritonavir, quinupristin

106
Q

Which drugs cause thrombocytopenia

A

Quinine, abciximab, NSAIDS, furosemide, ABx, anti-epileptics, heparin

107
Q

Which drugs precipitate attacks of acute intermittent porphyria

A

Barbiturates, halothane, benzodiazepines, alcohol, COCP, sulphonamides

108
Q

Which cancer is at increased risk with tamoxifen treatment

A

Endometrial cancer

109
Q

Which electrolyte abnormality classically precipitates digoxin toxicity

A

Hypokalaemia (digoxin can bind more easily to ATPase pump thus increased effect of the drug)

110
Q

What is the mechanism of action of cyanide poisoning

A

Inhibits cytochrome oxidase C

111
Q

What poisoning is likely with burning plastics e.g. in a house fire

A

Cyanide poisoning

112
Q

What is the MOA of amiloride

A

Blocks epithelial sodium channels

113
Q

What are the therapeutic uses of botox

A

Blepharospasm, hemifacial spasm, focal spasticity, spasmodic torticollis, hyperhidrosis of axillae, achalasia

114
Q

What is the MOA of ustekinumab

A

IL-12 and IL-23 blocker

115
Q

What is the MOA of etanercept

A

Anti-TNF

116
Q

What are the indications for haemodialysis in salicylate overdose

A

Serum conc. >700, metabolic acidosis resistant to treatment, acute renal failure, pulmonary oedema, seizures, coma

117
Q

What is the most useful initial test for testosterone abuse

A

Urinary testosterone/epitestosterone ratio

118
Q

Which drugs trigger psoriasis

A

Lithium, antimalarials, NSAIDS, beta blockers

119
Q

Which drugs trigger MG

A

Penicillamine, beta blockers, lithium, gentamicin, phenytoin

120
Q

What is used to terminate VT in digoxin overdose

A

Phenytoin

121
Q

What is the MOA of the -azoles (antifungals)

A

Inhibit conversion of lanosterol to ergosterol

122
Q

Which antihypertensive increases severity of anaphylactic reactions

A

ACE inhibitors

123
Q

Which anti-TB drug causes drug induced lupus

A

Isoniazid

124
Q

Which antihypertensive is known to cause drug induced lupus

A

Hydralazine

125
Q

Which overdoses is multiple-activated charcoal most useful

A

Carbamazepine, dapsone, phenobarbitone, digoxin, theophylline, quinine

126
Q

What is the initial treatment of serotonin syndrome

A

Benzodiazepines

127
Q

What is opisthotonus

A

Neck extended, back arched, arms internally rotated and elbows extended (seen in acute dystonic reaction)

128
Q

What is the treatment of seizures relating to benzodiazepine withdrawal

A

Long acting benzo e.g. IV diazepam then titrate to effect

129
Q

What class of drug is dothiepin

A

TCA

130
Q

Deficiency in which enzyme leads to severe 5-FU toxicity

A

DPD

131
Q

What causes progressively increasing muscular rigidity as inhaled anaesthetics are introduced

A

Malignant hyperthermia

132
Q

What is the treatment of theophylline toxicity with seizures

A

Charcoal haemoperfusion

133
Q

What is the treatment of methotrexate overdose

A

Calcium folinate

MRCP (16 decks)

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