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MRCP > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Which drugs cause impaired glucose tolerance?

A

TASTINg Sugar (impaired glucose tolerance)

Thiazides
Antiphychotics
Steroids
T cell in inhibitors (tacrolimus |&| cyclosporin)
Interferon alpha
Nicotinic acid (niacin N3)
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2
Q

What is the MOA of aspirin?

A

IRreversible inhibition of COX 1 and 2

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3
Q

What does aspirin increase the bodies reaction to? (three other drugs)

A

oral hypoglycaemics
warfarin
steroids

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4
Q

Tx of cyanide poisoning?

A

B12 (binds to cyanide to stop it being dangerous)

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5
Q

In paracetamol OD, what marker after 24hrs would make you consider the patient for a liver transplant?

A

An arterial pH <7.3, 24 hours after ingestion

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6
Q

How ‘staggered’ qualifies a staggered OD?

A

an overdose is considered staggered if all the tablets were not taken within 1 hour

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7
Q

What is the MOA of metformin?

A

activation of the AMP-activated protein kinase (AMPK)

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8
Q

What class of medication is metformin in?

A

Biguanides

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9
Q

What is the MOA of HIT?

A

antibodies form against complexes of platelet factor 4 (PF4) and heparin

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10
Q

What is the MOA of allopurinol?

A

AllopurINol = INhibits Xanthine Oxidase

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11
Q

Main troublesome SE of Mg?

A

Diarrhoea

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12
Q

Causes of low Mg?

A

HypoMAGNesia

M = metabolic: Gitelmans + Bartters
A = alcohol
G = gut: diarrhoea
N = nutrition: TPN

Also drugs: thiazides
Electrolytes: hypoK, hyperCa

MAGNet
E = electrolytes
T = thiazides/loop/PPIs

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13
Q

Patients at a high risk of severe cutaneous adverse reaction should be screened for what allele?

A

the HLA-B *5801 allele

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14
Q

What do you need to be careful of co-prescribing with allopurinol and why?

A

Azathioprine
Because azathioprine breaks down into the active compound 6-mercaptopurine. This is usually further broken down by Xanthine Oxidase. Therefore when allopurinol stops XO working it can lead to v high levels of 6-mercaptopurine.

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15
Q

What other drugs need careful co-prescribing with allopurinol?

A

Cyclophosphamide
allopurinol reduces renal clearance, therefore may cause marrow toxicity

Theophylline
allopurinol causes an increase in plasma concentration of theophylline by inhibiting its breakdown

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16
Q

SEs of quinolones?

A 
Tendon damage
Lengthens QT (think stomachs Ea)
LOWERS the seizure threshold in epilepsy
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17
Q

CIs for quinolones?

A

Pregnancy + G6PD

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18
Q

Lithium therapeutic range?

A

0.4-1

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19
Q

What can precipitate lithium toxicity?

A

Not diluted: dehydration
Not excreted: renal failure
drugs: diuretics (especially thiazides), ACEi/ARBs, NSAIDs and metronidazole

Same DAMN drugs are nephrotoxic but with metro rather than metformin

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20
Q

SEs of lithium use and signs of toxicity?

A 
SE:
Nausea
Fine tremor
Weight gain + oedema
Polydipsia + polyuria
Hypothyroidism
Toxicity:
Vomiting
Coarse tremor
Diarrhoea
Slurred speech/ataxia/confusion
Convulsions/coma
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21
Q

Treatment of lithium toxicity?

A

IV fluids
Haemodialysis in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this

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22
Q

What are the effects of excessive Ach?

A 
DUMBELS
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweating
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23
Q

Management of organophosphate poisoning?

A

Atropine

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24
Q

What is the MOA of sodium bicarb in Tx of lithium toxicity?

A

Increases urine alkalinity

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25
Q

When is quinine given if not for its antimalarial properties?

A

Leg cramps

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26
Q

4 hallmark symptoms and two effects of quinine overdose?

A

Hallmarks are tinnitus, visual blurring (think retinopathy), flushed and dry skin and abdominal pain

Effects: cardiac arrhythmias, hypoglycaemia

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27
Q

Name of quinine OD?

A

Cinchonism

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28
Q

Adverse effects of ciclosporin?

A 
(note how everything is increased - fluid, BP, K+, hair, gums, glucose)
nephrotoxicity
hepatotoxicity
fluid retention
HTN
hyperkalaemia
hypertrichosis
gingival hyperplasia
tremor
impaired glucose tolerance
hyperlipidaemia
increased susceptibility to severe infection
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29
Q

How to treat adrenaline induced ischaemia e.g. epipen to the hand?

A

Adrenaline induced ischaemia - phentolamine (alpha antagonist)

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30
Q

How to remember the general classes of anti-arrhythmic drugs?

A 
Son of a B*tch is Politically Correct
1 Sodium blocker 
2 Beta blocker 
3 Potassium blocker 
4 calcium blocker
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31
Q

How to remember the class 1 anti-arrythmics?

A

Double Quarter Pounder with Tomato Lettuce Mayo, also Fries Please
Disopyramide Quinidine Procainamide(Ia)/ Tocainide Lidocaine Mexilitine(Ib)/ Flecainide Propafenone (Ic)

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32
Q

Drugs that are CI in pregnancy?

A

CATS CRAWSS

Abs:
Quinolones (ciprofloxacin)
Aminoglycosides - Ototoxicity
Tetracyclines - Discoloured teeth
Sulphonamides + trimethoprim
Cytotoxic agents
Retinoids (topical + PO)
ACEi/ARBs - renal dysgenesis/CF abnormalities
Warfarin - CF abnormalities
Statins
Sulfonylureas
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33
Q

What is the MOA of cocaine?

A

cocaine blocks the uptake of dopamine, noradrenaline and serotonin

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34
Q

SEs of cocaine use?

A

Cocaine - Eric Clapton

E - Elevated BP
R - Rhabdomyolysis
I - Ischaemic Collitis
C - Coronary vasospasm

C - convulsions
L - long QT and QRS
A - Aortic dissection
P - Psychosis
Ton - Tone (increases) / reflexes (increases)
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35
Q

Management of cocaine OD? With CP? with HTN?

A

Benzodiazepines
CP - GTN spray
HTN - Na nitroprusside

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36
Q

MOA of cyclosporin/tacrolimus?

A

Ciclosporin + tacrolimus: inhibit calcineurin thus decreasing IL-2

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37
Q

What is the MOA of cyanide?

A

Cyanide inhibits the enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain.

Think all ‘c’s

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38
Q

Causes of drug induced photosensitivity?

A 
SEE - ciprofloxacin
H - hypoglycaemics - sulphonylureas 
(i)
S - sulphonamides
T - tetracyclines, thiazides 
A - amiodarone
N - NSAIDs e.g. piroxicam
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39
Q

What would you try if metformin can’t be tolerated in T2 DM?

A

MR metformin

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40
Q

Two examples of drugs that work on nuclear receptors?

A

Prednisolone

Levothyroxine

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41
Q

Drugs which can be cleared with haemodialysis?

A

BLAST

Barbiturate
Lithium
Alcohol (inc methanol, ethylene glycol)
Salicylates
Theophyllines (charcoal haemoperfusion is preferable)
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42
Q

What problem in the kidneys can aminoglycosides cause?

A

Acute tubular necrosis

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43
Q

How quickly can you titrate metformin?

A

Earliest one week d/t risk of diarrhoea

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44
Q

Treatment for tricyclic OD?

A

Bicarbonates

45
Q

TCA OD symptoms?

A

Anticholinergic: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision, urinary retention

Features of severe poisoning include:
arrhythmias (can cause prolonged QT/VT)
seizures + coma

46
Q

Drugs causing ocular problems?

Cataracts/corneal opacities/optic neuritis/retinopathy

A 
Cataracts: steroids
Corneal opacities: amiodarone, indomethacin
Optic neuritis:
ethambutol
amiodarone
metronidazole
Retinopathy: chloroquine, quinine
47
Q

SEs of TB drugs?

A

Rifampicin -> Orange bodily fluids, rash, hepatotoxicity, drug interactions
Isoniazid -> Peripheral neuropathy, psychosis, hepatotoxicity
Pyrazinamide -> Arthralgia, gout, hepatotoxicity, nausea
Ethambutol -> Optic neuritis, rash

RIP: Liver

48
Q

Drugs causing urticarial rash?

A 
NAPPY
Nsaid
Aspirin
Penicillin
o(PY)iates
49
Q

What may be protective if taken with a paracetamol OD?

A

Acute alcohol intake

50
Q

What increases the toxic effect of paracetamol (drugs)?

A

liver enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St John’s Wort)

51
Q

Drug induced thrombocytopaenia?

A 
QANADAH
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
52
Q

Common drugs to cause DRESS syndrome?

A

ALLOPURINOL, anti-epileptics, antibiotics, immunosuppressants, HIV treatment and NSAIDS

53
Q

Symptoms of DRESS syndrome?

A

extensive skin rash, high fever, and organ involvement, supported by a finding of eosinophilia and abnormal liver function tests

54
Q

What does DRESS mean?

A

drug reaction with eosinophilia and systemic symptoms

55
Q

Drugs that may precipitate an attack of acute intermittent porphyria?

A 
She Has Belly Aches Because Of porphyria:
Sulphonamides
Halothane
Barbiturates
Alcohol
Benzodiazepines
OCP
56
Q

When to take therapeutic drug levels for lithium, ciclosporin, digoxin and phenytoin?

A

Phenytoin + ciclosporin - just before dose
Digoxin - 6hrs post-dose
Lithium - 12hrs post-dose

i have a Date @ 6, so i will be Late @ 12.
Call before you check and PHone if in doubt.

57
Q

SEs of verapamil?

A 
Heart failure
Ankle swelling
Flushing
Headaches
CONSTIPATION
58
Q

How to treat acute dystonic reactions e.g. oculogyric crisis?

A

benztropine or procyclidine

59
Q

What is Ethylene glycol?

A

Antifreeze

60
Q

Features of antifreeze poisoning?

A

Stage 1: symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness
Stage 2: metabolic acidosis with high anion gap and high osmolar gap. Also tachycardia, hypertension
Stage 3: acute kidney injury

61
Q

Management of ethylene glycol poisoning?

A

Fomepizole

62
Q

MOA of fomepizole?

A

competitive inhibition of alcohol dehydrogenase

63
Q

Other than acidosis, what three factors are needed for liver transplant consideration following paracetamol OD?

A

All of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

64
Q

Which one of the following enzymes is involved in phase I drug metabolism?

A

Alcohol dehydrogenase

65
Q

Macrolide SEs?

A

prolongation of the QT interval
GI side-effects are common. Nausea is less with clarithromycin than erythromycin
cholestatic jaundice: risk may be reduced if erythromycin stearate is used
P450 inhibitor
azithromycin is associated with hearing loss and tinnitus

66
Q

Drugs that cause photosensitivity?

A

SEE (C) HiS TAN

cipro
hypoglycaemics - sulphonylureas
sulphonamides
tetracylines, thiazides
amiodarone
nsaids
67
Q

Which two medications can be given to prevent alcohol ingestion in alcoholics?

A

Acamprosate - decreases cravings
Disulfiram - blocks alc metabolism which induces an accumulation of acetaldehyde leading to headaches, flushing and nausea

aCam - cravings
diSul - sick

68
Q

What is the MOA of benzos?

A

ENHANCE the effect of the INHibitory GABA neurotransmitter by increasing the FREQUENCY of chloride channels

69
Q

How do you withdraw benzos if people are dependent on them?

A

steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight

70
Q

What is the MOA of Metoclopramide and Domperidone?

A

Dopamine receptor ANtagonists

71
Q

Adverse effects of dopamine agonists?

A

nausea/vomiting
postural hypotension
hallucinations
daytime somnolence

72
Q

Which electrolyte abnormalities can predispose you to digoxin toxicity?

A

Low pH, temp, K, magnesium, thyroid
High Ca, Na

Think crisp packets (ie PKT) are always half-filled with air empty (ie MT)
MT PKT (empty ie low) - Magnesium, Temp, pH, Potassium (k+), thyroid

Fizzy drinks are always full (or high) and come in a CaN
CaN - Calcium and Sodium (Na)

73
Q

Digoxin MOA?

A

Inhibits the Na+/K+ ATPase pump

74
Q

Treatment of lidocaine toxicity?

A

IV 20% lipid emulsion

75
Q

Possible treatment for hyperthermia linked to ecstasy use?

A

dantrolene may be used for hyperthermia if simple measures fail

76
Q

How to calculate the anion gap?

A

[Na+] + [K+]} - {[HCO3-] + [Cl-]

77
Q

Best anti-sickness for motion sickness?

A

hyoscine > cyclizine > promethazine

78
Q

Adverse effect of octreotide?

A

gallstones (secondary to biliary stasis)

79
Q

What are patients receiving CHOP chemo particularly at risk of?

A

Tumour lysis syndrome

Give allopurinol

80
Q

Which antibiotics lower the seizure threshold?

A

Quinolones

81
Q

What is the life-threatening dose of paracetamol?

A

> 12g (24 tablets)

82
Q

Ciclosporin side-effects?

A

everything is increased - fluid, BP, K+, hair, gums, glucose

83
Q

Blood test to help differentiate between CO and cyanide poisoning?

A

Very high lactate in cyanide, not in CO

84
Q

Antibiotics to avoid in renal failure?

A

tetracycline, nitrofurantoin

85
Q

What would P450 enzyme inducers do in the event of a paracetamol overdose?

A

Increase the action of p450, therefore breaking down paracetamol into its toxic metabolites

86
Q

What is the difference between T1 and T2 amiodarone induced thyrotoxicosis?

A

T1: Excess iodine-induced thyroid hormone synthesis Goitre
Management: Carbimazole or potassium perchlorate

T2: Amiodarone-related destructive thyroiditis
Absent goitre
Mx: Corticosteroids

87
Q

What is MOA of tamoxifen?

A

Selective oEstrogen Receptor Modulator (SERM)

Acts as an oestrogen receptor antagonist and partial agonist

88
Q

What are the adverse effects of tamoxifen?

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

89
Q

What class of drug is Ondansetron in?

A

5-HT3 receptor antagonist

90
Q

Name two 5HT receptor agonists?

A

Sumatriptan (5-HT1D)

Ergotamine (5-HT1)

91
Q

What is the role alpha-1 receptor and example of agonists + antagonists?

A

Mainly post-synaptic

Vasoconstriction
GI SM constriction
Hepatic glycogenolysis

Agonist: phenylephrine
Antagonist: doxazosin (alpha-1a -> tamsulosin)

92
Q

What is the role alpha-2 receptor and example of agonists + antagonists?

A

Mainly pre-synaptic

insulin inhibitor
platelet aggregation

Agonist: clonidine
Antagonist: yohimbine

93
Q

What is the role beta-1 receptor and example of agonists + antagonists?

A

HEART
Increases HR and force

Agonist: dobutamine
Antagonist: atenolol

94
Q

What is the role beta-2 receptor and example of agonists + antagonists?

A

LUNG + SM + SKELETAL MUSCLE

Bronchodilation
Vasodilation
Increased muscle contractions

Agonist: salbutamol

95
Q

What is the role beta-3 receptor?

A

Lipolysis

96
Q

Example of alpha 1+2 antagonist, beta 1+2 antagonist, and generalised alpha and beta antagonist?

A

Alpha 1+2 antagonist - phenoxybenzamine
Beta 1+2 antagonist - propranolol
Generalised alpha and beta antagonist - carvediolol and labetalol

97
Q

What occurs in phase 1 drug metabolism, where, and what enzymes are involved?

A

Oxidation, reduction, hydrolysis
p450 enzymes, alcohol dehydrogenase
Usually occurs in the liver

98
Q

What occurs in phase 2 drug metabolism and where?

A

Conjugation

In the liver

99
Q

Which drugs are excreted by zero order kinetics?

A

Police Stop Heavy Drinkers

Phenytoin
Salicyclates
Heparin
Alcohol

100
Q

Which drugs are affected by acetylator status?

A

SHIP’D

Sulphasalazine
Hydralazine
Isoniazid
Procainamide
Dapsone
101
Q

What interacts with macrolides?

A

Statins -> increase risk of myopathy/rhabdomyolysis

Amiodarone -> increases QT risk

102
Q

Drugs causing urinary retention?

A 
Nice TOAD
NSAIDs
TCAs
Opioids
Anticholinergics
Disopyramide
103
Q

What is the general action of heparins?

A

Anti-thrombin 3

104
Q

How to monitor standard heparins and LMWH?

A

Heparins -> APTT

LMWH -> Anti-factor Xa

105
Q

What is the MOA of HIT?

A

Plts release platelet factor 4
Binds to heparin
Which bind to IgGs forming an immune complex
These are recognised by the FC portion of platelets and leads to both thrombosis and thrombocytopaenia

106
Q

UKMEC3 (dis>adv) for COCP

A 
>35yrs and smoking <15/day
BMI >35
FH of first degree relative with VTE <45yrs
Controlled HTN
Immobility
BRCA1 or 2 positive
Current GB disease
107
Q

UKMEC4 (contraindications) for COCP

A 
>35yrs and smoking >15/day
BMI >40
Migraine with aura
Hx VTE/stroke/IHD
Breastfeeding <6wks post-partum (recent change from 6m to 6w)
Uncontrolled HTN
Current breast Ca
108
Q

COCP risk and protective factors?

A

RISK: IHD, VTE, stroke, breast + cervical Ca
PROTECTIVE: Colorectal + ovarian + endometrial Ca, also PID

MRCP (14 decks)

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