Pharmacology Flashcards
1
Q
Which drugs are affected by acetylator status
A
Isoniazid Procainamide Hydralazine Dapsone Sulfasalazine
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
3
Q
What causes heparin induced thrombocytopenia
A
Antibodies form against complexes of platelet factor 4 and heparin
4
Q
Which drugs can be cleared by haemodialysis
A
BLAST
Barbiturates, lithium, alcohol, salicylates, theophyllines
5
Q
Which drugs have significant first pass metabolism
A
Aspirin, ISDN, GTN, lignocaine, propranolol, verapamil, isoprenaline, testosterone, hydrocortisone
6
Q
Which drugs exhibit zero order kinetics
A
Phenytoin, high dose aspirin, heparin, ethanol
7
Q
When is best time to check phenytoin and ciclosporin levels
A
Immediately before next dose
8
Q
When is best to check lithium levels
A
12 hrs post dose
9
Q
When is best to check digoxin levels
A
6 hrs post dose
10
Q
Which drugs commonly cause urticaria
A
Aspirin
Penicillins
NSAIDs
Opiates
11
Q
Which drug can cause yellow tinting of vision
A
Digoxin
12
Q
Which drug can cause blue tinting of vision
A
Sildenafil
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
14
Q
Which electrolyte abnormality classically causes digoxin toxicity
A
Hypokalaemia (digoxin binds to same same on ATPase pump as K+)
15
Q
What are the indications for hyperbaric oxygen in CO poisoning
A
Carboxyhaemoglobin concentration >25%, LOC, neurology, MI/arrhythmia, pregnancy
16
Q
What are the adverse effects of ciclosporin
A
Nephrotoxicity, hepatotoxicity, fluid retention, hypertension, hyperkalaemia, hypertrichosis, gingival hyperplasia, tremor, impaired glucose tolerance, hyperlipidaemia
17
Q
What is the strongest indication for liver transplant after paracetamol overdose
A
Arterial pH <7.3, 24hrs after ingestion
18
Q
What is the best action if metformin is not tolerated due to side effects
A
Try MR formulation of metformin
19
Q
What are the causes of low magnesium
A
Diuretics, PPIs, TPN, diarrhoea, alcohol, hypokalaemia, hypercalcaemia, gitleman’s, bartter’s
20
Q
Which drugs interact with allopurinol
A
Azathioprine, cyclophosphamide, theophylline
21
Q
Which CCB can cause constipation
A
Verapamil
22
Q
What is the MOA of aspirin
A
Non-reversible COX1 and 2 inhibitor
23
Q
Which drugs cause corneal opacities
A
Amiodarone, indomethacin
24
Q
Which drugs cause optic neuritis
A
Ethambutol, amiodarone, metronidazole
25
Which drugs cause impaired glucose tolerance
Thiazides, furosemide, steroids, tacrolimus, ciclosporin, interferon-alpha, nicotinic acid, antipsychotics
26
What is the MOA of phenytoin
Binds to sodium channels to increase their refractory period
27
What are the acute adverse effects of phenytoin
Dizziness, diplopia, nystagmus, slurred speech, ataxia
28
What are the chronic adverse effects of phenytoin
Gingival hyperplasia, hirsutism, coarsening of facial features, megaloblastic anaemia, peripheral neuropathy, osteomalacia, lymphadenopathy, dyskinesia
29
What is the MOA of infliximab
Anti-TNF
30
What is the MOA of cetuximab
EGFR antagonist
31
What is the MOA of alemtuzumab
Anti-CD52
32
What is the MOA of abciximab
Glycoprotein IIb/IIIa receptor antagonist
33
Which P450 subtype breaks down warfarin
CYP2C9
34
Which P450 subtype breaks down alcohol
CYP2E1
35
Which antibiotic can precipitate lithium toxicity
Metronidazole
36
What is the MOA of disulfiram
Inhibits acetaldehyde dehydrogenase- unpleasant side effects
37
What is the MOA of acamprosate
NMDA antagonist - reduces craving
38
Which poisoning causes widespread deposits of calcium oxalate crystals
Ethylene glycol
39
What is the treatment of ethylene glycol toxicity
Fomepizole/ethanol - competitive inhibitor for alcohol dehydrogenase
40
Which poisoning seen in a middle aged homeless man causes snow field cataracts
Methanol poisoning
41
Which drug has the highest chance of smoking cessation
Bupropion
42
What is the MOA of varencycline
Nicotinic agonist
43
What is the MOA of bupropion
NE and dopamine reuptake inhibitor, nicotinic antagonist
44
Which smoking cessation therapy should be avoided in epilepsy
Bupropion
45
Which poisoning causes brick red skin and smelling of bitter almonds
Cyanide
46
What is the treatment of cyanide poisoning
IV hydroxocobalamin or IV dicobalt edetate
47
What are malathion and parathion
Organophosphate insecticides
48
What is the treatment of acetylcholinesterase inhibition poisoning (organophosphate/nerve gas)
IV atropine, pralidoxime
Remove clothes, wash contaminated areas
49
Which poisoning causes pink/cherry red skin and confusion
Carbon monoxide
50
Which poisoning causes mixed sensorimotor polyneuropathy and Mee’s lines on finger nails
Arsenic poisoning (pesticides)
51
Which poisoning causes type 4 RTA and basophilic stippling of RBCs
Lead poisoning
52
What blood lead level is diagnostic
>10
53
What are the symptoms/signs of lead poisoning
Motor neuropathy, blue lines on gum margins
54
What is the treatment of lead poisoning
Dimercaprol (DMSA), calcium edetate
55
Which interferons bind to type 1 receptors
INF-alpha, INF-beta
56
Which cells produce INF-alpha
Leukocytes
57
Which cells produce INF-beta
Fibroblasts
58
Which cells produce INF-gamma
T lymphocytes and NK cells
59
What condition is INF-beta used in
Relapsing-remitting MS
60
What conditions are INF-gamma used in
Chronic granulomatous disease, osteopetrosis
61
What conditions are INF-alpha used in
HBV, HCV, Kaposi’s sarcoma, metastatic renal Ca, hairy cell leukaemia
62
Which drugs can cause sensorineural deafness
IV furosemide, IV vancomycin, IV erythromycin
63
What is the treatment of severe serotonin syndrome
Cyproheptadine
64
What is the treatment of neuroleptic malignant syndrome
Bromocriptine
65
Where does levothyroxine act
Nuclear receptors
66
What are the side effects of lithium
Goitre/hypothyroidism, fine tremor, weight gain, diarrhoea, T wave flattening/inversion, nephrogenic diabetes insipidus, hypercalcaemia, hypermagnasaemia
67
Which drugs cause a photosensitive rash
Amiodarone, thiazides, NSAIDs, sulphonylureas, tetracyclines, sulphonamides, ciprofloxacin, psoralen, ACEi/ARB
68
What are the causes of gingival hyperplasia
Phenytoin, cyclosporin, nifedipine, AML
69
What do Beta-3 adrenoreceptors cause
Lipolysis
70
Which adrenoreceptor inhibits adenylate cyclase
Alpha-2
| n.b. All beta receptors stimulate adenylate cyclase
71
What class of drug is phenylephrine
Alpha-1 agonist
72
What class of drug is dobutamine
Beta-1 agonist
73
What class of drug is clonidine
Alpha-2 agonist
74
When should sodium bicarbonate be given in TCA overdose
PH <7.1, QRS >160, arrhythmias, hypotension
75
What adverse effect is common with trastuzumab
Cardiotoxicity - echo before starting
76
Which TB drug needs dose-adjusting in renal failure
Ethambutol
77
Which antibiotic is contra-indicated in G6PD deficiency
Ciprofloxacin
78
Which antibiotics reduced the efficacy of the COCP
Only enzyme-inducing antibiotics e.g. rifampicin
79
Which poisoning leads to mixed respiratory alkalosis and metabolic acidosis
Salicylate poisoning
80
What concentration of salicylate is an indication for haemodialysis in overdose
>700
81
What causes aminoglycoside nephrotoxicity
Acute tubular necrosis
82
When is haemodialysis indicated in lithium toxicity
Conc >2 with neuro symptoms or renal failure
83
What is the MOA of metformin
Activates the AMP-activated protein kinase (AMPK), increases insulin sensitivity, decreases hepatic gluconeogenesis
84
When should gentamicin doses be checked
Peak (1hr after administration) and trough (just before next dose)
85
What should be adjusted if the peak level of gentamicin is too high
Decrease dose
86
What should be adjusted if the trough level of gentamicin is too high
Increase interval between doses
87
What is the most common adverse effect of the progesterone-only pill
Irregular vaginal bleeding
88
Which anti-anginal can cause anal ulceration
Nicorandil
89
What is the MOA of ketamine
NMDA receptor antagonist
90
What is the MOA of propofol
GABA receptor agonist
91
Which TCAs are most dangerous in overdose
Amitriptyline, dosulepin
92
Which anti-glycaemic drug is contraindicated in history of bladder cancer
TZDs (pioglitazone)
93
What is the pathophysiology of amiodarone-induced thyrotoxicosis type 1
Excess iodine-induced thyroid hormone synthesis
94
What is the pathophysiology of amiodarone-induced thyrotoxicosis type 2
Amiodarone-related destructive thyroiditis
95
Which amiodarone-induced thyrotoxicosis presents with goitre
AIT type 1
96
What is the treatment of amiodarone-induced thyrotoxicosis type 1
Carbimazole
97
What is the treatment of amiodarone-induced thyrotoxicosis type 2
Corticosteroids
98
What causes amiodarone-induced hypothyroidism
High iodine content of amiodarone - Wolf-Chaikoff effect
99
When can amiodarone be continued in amiodarone-related thyroid disease
Amiodarone-induced hypothyroidism (not -induced thyrotoxicosis)
100
What is the treatment of symptomatic caustic ingestion
High dose IV PPI and urgent endoscopy
101
Which antibiotic is teratogenic leading to grey baby syndrome
Chloramphenicol
102
What can smoking and cocaine cause during pregnancy
Preterm labour
103
What class of drug is tamsulosin
Alpha-1a antagonist (mainly acts on urogenital tract)
104
What are nivolumab and ipilimumab used to treat
Metastatic melanoma
105
What are the other drugs that are enzyme inhibitors not included in AO DEVICES
Cimetidine, amiodarone, ketoconazole, fluconazole, fluoxetine, sertraline, ritonavir, quinupristin
106
Which drugs cause thrombocytopenia
Quinine, abciximab, NSAIDS, furosemide, ABx, anti-epileptics, heparin
107
Which drugs precipitate attacks of acute intermittent porphyria
Barbiturates, halothane, benzodiazepines, alcohol, COCP, sulphonamides
108
Which cancer is at increased risk with tamoxifen treatment
Endometrial cancer
109
Which electrolyte abnormality classically precipitates digoxin toxicity
Hypokalaemia (digoxin can bind more easily to ATPase pump thus increased effect of the drug)
110
What is the mechanism of action of cyanide poisoning
Inhibits cytochrome oxidase C
111
What poisoning is likely with burning plastics e.g. in a house fire
Cyanide poisoning
112
What is the MOA of amiloride
Blocks epithelial sodium channels
113
What are the therapeutic uses of botox
Blepharospasm, hemifacial spasm, focal spasticity, spasmodic torticollis, hyperhidrosis of axillae, achalasia
114
What is the MOA of ustekinumab
IL-12 and IL-23 blocker
115
What is the MOA of etanercept
Anti-TNF
116
What are the indications for haemodialysis in salicylate overdose
Serum conc. >700, metabolic acidosis resistant to treatment, acute renal failure, pulmonary oedema, seizures, coma
117
What is the most useful initial test for testosterone abuse
Urinary testosterone/epitestosterone ratio
118
Which drugs trigger psoriasis
Lithium, antimalarials, NSAIDS, beta blockers
119
Which drugs trigger MG
Penicillamine, beta blockers, lithium, gentamicin, phenytoin
120
What is used to terminate VT in digoxin overdose
Phenytoin
121
What is the MOA of the -azoles (antifungals)
Inhibit conversion of lanosterol to ergosterol
122
Which antihypertensive increases severity of anaphylactic reactions
ACE inhibitors
123
Which anti-TB drug causes drug induced lupus
Isoniazid
124
Which antihypertensive is known to cause drug induced lupus
Hydralazine
125
Which overdoses is multiple-activated charcoal most useful
Carbamazepine, dapsone, phenobarbitone, digoxin, theophylline, quinine
126
What is the initial treatment of serotonin syndrome
Benzodiazepines
127
What is opisthotonus
Neck extended, back arched, arms internally rotated and elbows extended (seen in acute dystonic reaction)
128
What is the treatment of seizures relating to benzodiazepine withdrawal
Long acting benzo e.g. IV diazepam then titrate to effect
129
What class of drug is dothiepin
TCA
130
Deficiency in which enzyme leads to severe 5-FU toxicity
DPD
131
What causes progressively increasing muscular rigidity as inhaled anaesthetics are introduced
Malignant hyperthermia
132
What is the treatment of theophylline toxicity with seizures
Charcoal haemoperfusion
133
What is the treatment of methotrexate overdose
Calcium folinate
