Pharmacology

Question 1

What drug should you give someone with ACS secondary to cocaine use?

Answer 1

Diazepam

Question 2

What UTI abx should be given in renal failure?

Answer 2

Trimethoprim should be given in preference to nitro. CKD stage 3 or worse.

Question 3

Visual changes with drugs?

Answer 3

blue vision: Viagra (‘the blue pill’)

yellow-green vision: digoxin

Question 4

Metformin titration regimen?

Answer 4

In steps of 1 week

One tablet with breakfast

Then BD

Then TDS

Question 5

Mechanism of action of metformin?

Answer 5

increases insulin sensitivity

decreases hepatic gluconeogenesis

may also reduce gastrointestinal absorption of carbohydrates

Question 6

Features of carbon monoxide poisoning?

Answer 6

headache: 90% of cases
nausea and vomiting: 50%
vertigo: 50%
confusion: 30%
subjective weakness: 20%
severe toxicity: 'pink' skin and mucosae, hyperpyrexia, arrhythmias, extrapyramidal features, coma, death

Question 7

Monitoring of statin therapy? Tests and how often?

Answer 7

LFTs at baseline, 3 months and 12 months

Question 8

Monitoring of ACEI therapy? Tests and how often?

Answer 8

U&E U&E prior to treatment
U&E after increasing dose
U&E at least annually

Question 9

Monitoring of amiodarone therapy? Tests and how often?

Answer 9

TFT, LFT, U&E, CXR prior to treatment

TFT, LFT every 6 months

Question 10

Monitoring of methotrexate therapy? Tests and how often?

Answer 10

FBC, LFT, U&E - regularly

The Committee on Safety of Medicines recommend ‘FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months’

Question 11

Monitoring of azathiorpine therapy? Tests and how often?

Answer 11

FBC, LFT before treatment

FBC weekly for the first 4 weeks

FBC, LFT every 3 months

Question 12

Monitoring of Lithium therapy? Tests and how often?

Answer 12

TFT, U&E prior to treatment

Lithium levels weekly until stabilised then every 3 months

TFT, U&E every 6 months

Question 13

Monitoring of Sodium valproate therapy? Tests and how often?

Answer 13

LFT, FBC before treatment

LFT ‘periodically’ during first 6 months

Question 14

Monitoring of glitazone therapy? Tests and how often?

Answer 14

LFT before treatment

LFT ‘regularly’ during treatment

Question 15

What bloods before TB therapy?

Answer 15

LFTs

Question 16

Treatment of lithium toxicity?

Answer 16

Hydration with normal saline

Dialysis if above does not work

Question 17

Management of TCA toxicity?

Answer 17

IV bicarb

Treat arrhythmias

Question 18

Treatment of salicylate toxicity?

Answer 18

IV bicarb

Dialysis second line

Question 19

Side effects of glitazones?

Answer 19

Weight gain
Fluid retention
Liver dysfunction
Fractures

Question 20

What drugs can’t you take sildenafil with?

Answer 20

Nicorandil and nitrates - similar effect

Question 21

What abx lower seizure threshold?

Answer 21

Ciprofloxacin

Question 22

What abx can lead to tendonitis?

Answer 22

Quinolones (cipro)

Question 23

Features of ecstasy poisoning?

Answer 23

neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
hyperthermia
rhabdomyolysis

Question 24

Minimum time needed from ingestion to take paracetamol level?

Answer 24

4 hours

Could give activated charcoal if presents before this (although needs to be within 1hr of taking OD)

Question 25

Confusion and pink mucosae points towards what diagnosis?

Answer 25

Carbon monoxide poisoning

Question 26

What meds may exacerbate CCF?

Answer 26

thiazolidinediones - pioglitazone is contraindicated as it causes fluid retention. Verapamil NSAIDs/glucocorticoids - fluid retention low-dose aspirin is an exception flecainide

Question 27

If Metformin IR not tolerated what could you try?

Answer 27

MR metformin then try second agent

Question 28

Adverse effects of tamoxifen?

Answer 28

menstrual disturbance: vaginal bleeding, amenorrhoea hot flushes - most likely venous thromboembolism endometrial cancer

Question 29

What drugs may cause urinary retention?

Answer 29

``` tricyclic antidepressants e.g. amitriptyline anticholinergics opioids NSAIDs disopyramide ```

Question 30

What electrolyte disturbance can precipitate digoxin toxicity?

Answer 30

Hypokalaemia

Question 31

What NSAID is contraindicated in cardiovascular disease?

Answer 31

Diclofenac

Question 32

What antidiabetic drug should you stop if someone is admitted with an MI?

Answer 32

Metformin

Question 33

P450 inducers?

Answer 33

PC BRASS Phenytoin Carbamazepine ``` Barbiturates Rifampicin Alcohol (chronic) Sulphonylureas St Johns wart (Smoking) ```

Question 34

P450 inhibitors?

Answer 34

AO DEVICESS Allopurinol Omeprazole ``` Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute intake) Sulphonamides SSRIs ```

Question 35

Beta blocker OD management?

Answer 35

if bradycardic then atropine | in resistant cases glucagon may be used

Question 36

features of organophosphate poisoning?

Answer 36

``` Salivation Lacrimation Urination Defecation/diarrhoea cardiovascular: hypotension, bradycardia also: small pupils, muscle fasciculation ```

Question 37

Which anti-TB drug is associated with visual changes?

Answer 37

Ethambutol

Question 38

Do you monitor digoxin levels routinely?

Answer 38

No

Question 39

Which ant-TB drug causes peripheral neuropathy?

Answer 39

Isoniazid

Question 40

Methanol poisoning management?

Answer 40

fomepizole or ethanol

Question 41

Digoxin toxicity mangement?

Answer 41

Specific antibodies

Question 42

When prescribing HRT what influences decision to prescribe continuous or cyclical?

Answer 42

Cyclical unless: - taken cyclical combined for at least 1 year or - it has been at least 1 year since their LMP or - it has been at least 2 years since their LMP, if they had premature menopause (menopause below the age of 40)

Question 43

What type of diuretics cause ototoxicity?

Answer 43

Loop diuretics

Question 44

In TB drugs what do Rifampicin and isoniazid do to the p450 system?

Answer 44

Rifampicin is an IDUCER Isoniazid is an INHIBITOR

Question 45

What abx to give in prostatitis?

Answer 45

Cipro or ofloxacin (quinolone)