Pharmacology Flashcards
What is the SSRI of choice for children and adolescents?
Fluoxetine
What are examples of CYP450 INDUCERS?
PC BRAS
Phenytoin
Carbamazepine
Barbiturates Rifampicin Alcohol (excess) Sulphonylureas St John's Wort
What are examples of CYP450 INHIBITORS?
INCREASE drug concentration
AO DEVICES
Allopurinol/amiodarone
Omeprazole
Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute) Sulphonamides + SSRIs
How long before surgery should you stop the COCP?
4 weeks
How long before surgery should you stop aspirin?
1-2 weeks
What are the contraindications to NSAID use?
No urine (AKI/CKD) Systolic dysfunction Asthma Indigestion (gastic ulcers etc) Drugs to thin blood/clotting abnormality
Which drugs are contraindicated in asthmatics?
B-blockers
NSAIDs
What is the maximum rate at which IV potassium should be given?
10mmol/hr
In which group of patient is cyclizine not recommended?
Those with cardiac failure, as it can worsen fluid retention
The elderly- it can contribute to anti-cholinergic effect e.g. drowsiness, confusion, urine retention
What time of day should amitriptyline be taken?
Night time
Which anti-emetic is recommended for use in Parkinson’s disease?
Domperidone
Does not cross the BBB
What electrolyte imbalance do thiazide diuretics cause?
Hypokalaemia
Hyponatraemia
Hypomagnasemia
HYPERcalcaemia
What are side effects of thiazide diuretics?
Electrolyte abnormalities- high calcium, low everything else
Precipitates attacks of gout
Increase glucose and lipids
Hypotension
What are side effects of ACE-inhibitors?
Worsened renal function in AKI
Dry cough
Hyperkalaemia
Angioedema
Which diuretics cause hypokalaemia?
Thiazide diuretics Loop diuretics (furosemide)
Which diuretics/antihypertensives cause HYPERkalaemia?
ACE-I
Spironolactone
What can be used instead of oxybutynin in the elderly to treat urinary urgency?
Mirabegron
Lower anti-cholinergic burden
Which antibiotic is contraindicated in those taking methotrexate?
Trimethoprim
Both folate antagonists
What are common side effects of calcium channel blockers?
Ankle oedema
May precipitate bradycardia/AV block
Which other antihypertensive medication should never be given with B-blockers?
Verapamil
Which medications cause hyponatraemia?
Thiazide diuretics (and most other diuretics) SSRIs- via SIADH Omeprazole Amiodarone Antipsychotics - via SIADH
What are the causes of hyponatraemia?
Hypovolemic: dehydration (fluid loss), Addison’s, Diuretics
Euvolemic: SIADH, psychogenic polydipsia, hypothyroidism
Hypervolemic: Heart/renal/liver failure, malnutrition
What are the signs of digoxin toxicity?
Yellow/green discolouration of vision Seeing halos around lights Arrhythmia- bradycardia, curved ST segment, TWI Nausea and confusion Hypokalaemia
What do you give in digoxin toxicity?
Digibind (digoxin antibody)
Potassium if necessary
What are the signs of lithium toxicity?
Early: tremor
Intermediate: tiredness
Late: arrhythmia, seizures, coma, renal failure, diabetes insipidus (nephrogenic)
What are the signs of phenytoin toxicity?
Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy Teratogenicity
When should gentamicin levels be taken?
In once daily regimens: trough level at 6-14 hours
In multiple daily doses: peak level 1 hour after administration, trough level at 6-14 hours
if the trough (pre-dose) level is high the interval between the doses should be increased
if the peak (post-dose) level is high the dose should be decreased
Which coagulation test is used to calculate INR?
PT
How would you manage a patient with high INR but no bleeding?
INR 5-8: withhold for two days and reduce dose / resume when INR <5 at reduced dose
INR >8: Omit warfarin and give oral vitamin K, resume when INR <5 at reduced dose
How would you manage a patient with high INR and a minor bleed?
Stop warfarin, IV vitamin K
+/- PCC/FFP depending on the situation
How much IV vitamin K should be given in high INR?
Minor bleed: 1-5mg
Major bleed 5-10mg
When should diltiazem not be used in patients with AF?
If there is concurrent heart failure and fluid retention
How is SVT managed?
Vagal manourvres
Adenosine 6mg rapid IV bolus
Try another 12 mg
Try another 12mg
How do you manage fast AF?
If onset <48 hours: DC cardioversion
Control rate with: B-blocker or diltizem (digoxin in HF)
Anticoagulate
What would you give in stable VT?
IV amiodarone 300mg over 20-60min
Further 900mg over 24hrs
What would you give in a patient with tachycardia and features of shock?
DC shock x <3
IV amiodarone
What is first line acute bradycardia management?
IV atropine
What is the antidote for benzodiazepine overdose?
Flumazenil
What is first line in organophosphate poisoning?
Atropine
Oxygen
Pralidoxime
How do you manage salicylate poisoning?
IV sodium bicarbonate Active cooling Activated charcoal if <1hr Haemodialysis Manage hypokalaemia
Which population of patients should not be prescribed pioglitazone?
Those with heart failure
What type of laxative is Senna?
Stimulant
What is the first line antibiotic in skin infections?
Flucloxacillin
What is the first line antibiotic in human or animal bites?
Co-amoxiclav
What is the key side effect of sulphonylureas (gliclazide)?
Hypoglycaemia
Should not miss meals
What monitoring is required with methotrexate?
Pre-treatment:
Exclude pregnancy and pregnancy prevention plan
FBC and LFT
Monitor:
Weekly FBC and LFT to monitor WBC + LF, 2-3monthly once stabilised
Counsel to present if signs of severe infection, especially sore throat
Which cancer risk is increased with combined HRT?
Breast
What is the added risk with oral HRT as opposed to transdermal?
Blood clots
What are the monitoring requirements for lithium?
Serum levels 12 hours after dose- target 0.4-1 (0.8-1 in acute mania)
What dose of adrenaline is indicated in: adult anaphylaxis, child anaphylaxis and cardiac arrest
Adult anaphylaxis: 500mg (0.5ml) 1:1000 IM
Cardiac arrest: 1ml 1:1000 or 10ml 1:10,000 IV
What medications can be used to aid alcohol cessation?
Disulfiram: promotes abstinence (contraindicated in IHD and psychosis)
Acamprosate: reduces cravings
When and how should you start allopurinol in gout?
2 weeks after an acute attack
Colchicine cover <6months to prevent allopurinol inducing an attack
Advise to look out for any sign of rash
What are the side effects of Amiodarone therapy?
Thyroid dysfunction Pulmonary fibrosis Bradycardia and long QT Liver fibrosis Photosensitivity Slate-grey appearance
How should carbon monoxide poisoning be managed?
100% oxygen
Hyperbaric oxygen
What are the key side effects of cyclosporin?
Gum hyperplasia Fluid retention Hyperkalaemia Hypertension Nephro and hepatotoxicity
What is first line management for most cocaine related problems?
Benzodiazepines
In which patients is diclofenac contraindicated?
ischaemic heart disease peripheral arterial disease cerebrovascular disease congestive heart failure asthmatics
What are common drug causes of urticaria?
aspirin
penicillins
NSAIDs
opiates
What monitoring should be done when initiating statins?
Baseline LFTs
Again 3m, 12m
What monitoring should be done when initiating amiodarone?
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
What bloods should be done before the initiation of sodium valproate?
LFT, FBC before treatment
LFT ‘periodically’ during first 6 months
Drugs causing lung fibrosis?
Amiodarone
Methotrexate
Nitrofurantoin
Cytotoxic agents
What drugs cause photosensitivity?
Thiazides Tetracyclines, sulphonamides, ciprofloxacin Amiodarone NSAIDs e.g. piroxicam Psoralens Sulphonylureas Isotretinoin
What can be given to reverse heparin overdose?
Protamine Sulphate
For how long should women going through premature menopause be given HRT?
Until the age of 50
What are the common side effects of macrolide antibiotics?
QT prolongation Interaction with warfarin (P450 inhibitor) GI side effects Cholestatic jaundice Interaction with statins
How should methanol ingestion be managed?
fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
haemodialysis
What are the causes of oligogyric crisis?
antipsychotics
metoclopramide
postencephalitic Parkinson’s disease
How is oligogyric crisis managed?
IV procyclidine
How would you manage TCA overdose?
IV bicarbonate
Dialysis
What would you give in cyanide poisoning?
Hydroxocobalamin;
also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
What are the contraindications for taking PDE5 inhibitors e.g. viagra?
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
What are potential side effects of PDE-5 inhibitors?
Blue tinge to vision Headaches Flushing GI side effects Priapism
What are the potential side effects of cipro/levofloxacin?
lower seizure threshold in patients with epilepsy tendon damage (including rupture) - the risk is increased in patients also taking steroids lengthens QT interval
How is serotonin syndrome managed?
supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
What is a rare but important side effect of DPP4 inhibitors?
Pancreatitis
What are the adverse effects of tamoxifen treatment?
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer
What are the side effects of rifampicin treatment?
Orange secretions
CYP450 inducer - reduced efficacy of medications
What are the side effects of isoniazid?
Peripheral neuropathy (prevent with pyridoxine)
Hepatitis
Agranulocytosis
CYP450 inhibitor - increases medication availability
What are the side effects of pyrazinamide?
Hyperuricaemia causing gout
Arthralgia/myalgia
Hepatitis
What are the side effects of ethambutol?
Optic neuritis
Hepatic problems
How would you differentiate between serotonin syndrome and neuroleptic malignant syndrome?
Serotonin: hyperreflexia, myoclonus
NMS: muscle rigidity, hyporeflexia
What are the potential side effects of sulphonylureas?
Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)
