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Finals Revision > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the SSRI of choice for children and adolescents?

A

Fluoxetine

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2
Q

What are examples of CYP450 INDUCERS?

A

PC BRAS

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (excess)
Sulphonylureas
St John's Wort
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3
Q

What are examples of CYP450 INHIBITORS?

A

INCREASE drug concentration
AO DEVICES

Allopurinol/amiodarone
Omeprazole

Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)
Sulphonamides + SSRIs
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4
Q

How long before surgery should you stop the COCP?

A

4 weeks

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5
Q

How long before surgery should you stop aspirin?

A

1-2 weeks

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6
Q

What are the contraindications to NSAID use?

A 
No urine (AKI/CKD)
Systolic dysfunction
Asthma
Indigestion (gastic ulcers etc)
Drugs to thin blood/clotting abnormality
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7
Q

Which drugs are contraindicated in asthmatics?

A

B-blockers

NSAIDs

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8
Q

What is the maximum rate at which IV potassium should be given?

A

10mmol/hr

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9
Q

In which group of patient is cyclizine not recommended?

A

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

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10
Q

What time of day should amitriptyline be taken?

A

Night time

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11
Q

Which anti-emetic is recommended for use in Parkinson’s disease?

A

Domperidone

Does not cross the BBB

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12
Q

What electrolyte imbalance do thiazide diuretics cause?

A

Hypokalaemia
Hyponatraemia
Hypomagnasemia
HYPERcalcaemia

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13
Q

What are side effects of thiazide diuretics?

A

Electrolyte abnormalities- high calcium, low everything else
Precipitates attacks of gout
Increase glucose and lipids
Hypotension

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14
Q

What are side effects of ACE-inhibitors?

A

Worsened renal function in AKI
Dry cough
Hyperkalaemia
Angioedema

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15
Q

Which diuretics cause hypokalaemia?

A 
Thiazide diuretics
Loop diuretics (furosemide)
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16
Q

Which diuretics/antihypertensives cause HYPERkalaemia?

A

ACE-I

Spironolactone

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17
Q

What can be used instead of oxybutynin in the elderly to treat urinary urgency?

A

Mirabegron

Lower anti-cholinergic burden

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18
Q

Which antibiotic is contraindicated in those taking methotrexate?

A

Trimethoprim

Both folate antagonists

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19
Q

What are common side effects of calcium channel blockers?

A

Ankle oedema

May precipitate bradycardia/AV block

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20
Q

Which other antihypertensive medication should never be given with B-blockers?

A

Verapamil

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21
Q

Which medications cause hyponatraemia?

A 
Thiazide diuretics (and most other diuretics)
SSRIs- via SIADH
Omeprazole
Amiodarone
Antipsychotics - via SIADH
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22
Q

What are the causes of hyponatraemia?

A

Hypovolemic: dehydration (fluid loss), Addison’s, Diuretics

Euvolemic: SIADH, psychogenic polydipsia, hypothyroidism

Hypervolemic: Heart/renal/liver failure, malnutrition

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23
Q

What are the signs of digoxin toxicity?

A 
Yellow/green discolouration of vision
Seeing halos around lights
Arrhythmia- bradycardia, curved ST segment, TWI
Nausea and confusion
Hypokalaemia
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24
Q

What do you give in digoxin toxicity?

A

Digibind (digoxin antibody)

Potassium if necessary

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25
Q

What are the signs of lithium toxicity?

A

Early: tremor

Intermediate: tiredness

Late: arrhythmia, seizures, coma, renal failure, diabetes insipidus (nephrogenic)

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26
Q

What are the signs of phenytoin toxicity?

A 
Gum hypertrophy
Ataxia
Nystagmus
Peripheral neuropathy
Teratogenicity
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27
Q

When should gentamicin levels be taken?

A

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

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28
Q

Which coagulation test is used to calculate INR?

A

PT

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29
Q

How would you manage a patient with high INR but no bleeding?

A

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

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30
Q

How would you manage a patient with high INR and a minor bleed?

A

Stop warfarin, IV vitamin K

+/- PCC/FFP depending on the situation

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31
Q

How much IV vitamin K should be given in high INR?

A

Minor bleed: 1-5mg

Major bleed 5-10mg

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32
Q

When should diltiazem not be used in patients with AF?

A

If there is concurrent heart failure and fluid retention

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33
Q

How is SVT managed?

A

Vagal manourvres
Adenosine 6mg rapid IV bolus
Try another 12 mg
Try another 12mg

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34
Q

How do you manage fast AF?

A

If onset <48 hours: DC cardioversion
Control rate with: B-blocker or diltizem (digoxin in HF)
Anticoagulate

35
Q

What would you give in stable VT?

A

IV amiodarone 300mg over 20-60min

Further 900mg over 24hrs

36
Q

What would you give in a patient with tachycardia and features of shock?

A

DC shock x <3

IV amiodarone

37
Q

What is first line acute bradycardia management?

A

IV atropine

38
Q

What is the antidote for benzodiazepine overdose?

A

Flumazenil

39
Q

What is first line in organophosphate poisoning?

A

Atropine
Oxygen
Pralidoxime

40
Q

How do you manage salicylate poisoning?

A 
IV sodium bicarbonate
Active cooling
Activated charcoal if <1hr
Haemodialysis
Manage hypokalaemia
41
Q

Which population of patients should not be prescribed pioglitazone?

A

Those with heart failure

42
Q

What type of laxative is Senna?

A

Stimulant

43
Q

What is the first line antibiotic in skin infections?

A

Flucloxacillin

44
Q

What is the first line antibiotic in human or animal bites?

A

Co-amoxiclav

45
Q

What is the key side effect of sulphonylureas (gliclazide)?

A

Hypoglycaemia

Should not miss meals

46
Q

What monitoring is required with methotrexate?

A

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

47
Q

Which cancer risk is increased with combined HRT?

A

Breast

48
Q

What is the added risk with oral HRT as opposed to transdermal?

A

Blood clots

49
Q

What are the monitoring requirements for lithium?

A

Serum levels 12 hours after dose- target 0.4-1 (0.8-1 in acute mania)

50
Q

What dose of adrenaline is indicated in: adult anaphylaxis, child anaphylaxis and cardiac arrest

A

Adult anaphylaxis: 500mg (0.5ml) 1:1000 IM

Cardiac arrest: 1ml 1:1000 or 10ml 1:10,000 IV

51
Q

What medications can be used to aid alcohol cessation?

A

Disulfiram: promotes abstinence (contraindicated in IHD and psychosis)

Acamprosate: reduces cravings

52
Q

When and how should you start allopurinol in gout?

A

2 weeks after an acute attack
Colchicine cover <6months to prevent allopurinol inducing an attack

Advise to look out for any sign of rash

53
Q

What are the side effects of Amiodarone therapy?

A 
Thyroid dysfunction
Pulmonary fibrosis
Bradycardia and long QT
Liver fibrosis
Photosensitivity
Slate-grey appearance
54
Q

How should carbon monoxide poisoning be managed?

A

100% oxygen

Hyperbaric oxygen

55
Q

What are the key side effects of cyclosporin?

A 
Gum hyperplasia
Fluid retention
Hyperkalaemia
Hypertension 
Nephro and hepatotoxicity
56
Q

What is first line management for most cocaine related problems?

A

Benzodiazepines

57
Q

In which patients is diclofenac contraindicated?

A 
ischaemic heart disease
peripheral arterial disease
cerebrovascular disease
congestive heart failure
asthmatics
58
Q

What are common drug causes of urticaria?

A

aspirin
penicillins
NSAIDs
opiates

59
Q

What monitoring should be done when initiating statins?

A

Baseline LFTs

Again 3m, 12m

60
Q

What monitoring should be done when initiating amiodarone?

A

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

TFT, LFT every 6 months

61
Q

What bloods should be done before the initiation of sodium valproate?

A

LFT, FBC before treatment

LFT ‘periodically’ during first 6 months

62
Q

Drugs causing lung fibrosis?

A

Amiodarone
Methotrexate
Nitrofurantoin
Cytotoxic agents

63
Q

What drugs cause photosensitivity?

A 
Thiazides
Tetracyclines, sulphonamides, ciprofloxacin
Amiodarone
NSAIDs e.g. piroxicam
Psoralens
Sulphonylureas
Isotretinoin
64
Q

What can be given to reverse heparin overdose?

A

Protamine Sulphate

65
Q

For how long should women going through premature menopause be given HRT?

A

Until the age of 50

66
Q

What are the common side effects of macrolide antibiotics?

A 
QT prolongation
Interaction with warfarin (P450 inhibitor)
GI side effects
Cholestatic jaundice
Interaction with statins
67
Q

How should methanol ingestion be managed?

A

fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
haemodialysis

68
Q

What are the causes of oligogyric crisis?

A

antipsychotics
metoclopramide
postencephalitic Parkinson’s disease

69
Q

How is oligogyric crisis managed?

A

IV procyclidine

70
Q

How would you manage TCA overdose?

A

IV bicarbonate

Dialysis

71
Q

What would you give in cyanide poisoning?

A

Hydroxocobalamin;

also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

72
Q

What are the contraindications for taking PDE5 inhibitors e.g. viagra?

A

patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)

73
Q

What are potential side effects of PDE-5 inhibitors?

A 
Blue tinge to vision
Headaches
Flushing
GI side effects
Priapism
74
Q

What are the potential side effects of cipro/levofloxacin?

A 
lower seizure threshold in patients with epilepsy
tendon damage (including rupture) - the risk is increased in patients also taking steroids
lengthens QT interval
75
Q

How is serotonin syndrome managed?

A

supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

76
Q

What is a rare but important side effect of DPP4 inhibitors?

A

Pancreatitis

77
Q

What are the adverse effects of tamoxifen treatment?

A

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

78
Q

What are the side effects of rifampicin treatment?

A

Orange secretions

CYP450 inducer - reduced efficacy of medications

79
Q

What are the side effects of isoniazid?

A

Peripheral neuropathy (prevent with pyridoxine)
Hepatitis
Agranulocytosis
CYP450 inhibitor - increases medication availability

80
Q

What are the side effects of pyrazinamide?

A

Hyperuricaemia causing gout
Arthralgia/myalgia
Hepatitis

81
Q

What are the side effects of ethambutol?

A

Optic neuritis

Hepatic problems

82
Q

How would you differentiate between serotonin syndrome and neuroleptic malignant syndrome?

A

Serotonin: hyperreflexia, myoclonus

NMS: muscle rigidity, hyporeflexia

83
Q

What are the potential side effects of sulphonylureas?

A

Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)

Finals Revision (23 decks)

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