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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
What are the signs of lithium toxicity?
Early: tremor Intermediate: tiredness Late: arrhythmia, seizures, coma, renal failure, diabetes insipidus (nephrogenic)
26
What are the signs of phenytoin toxicity?
``` Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy Teratogenicity ```
27
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
28
Which coagulation test is used to calculate INR?
PT
29
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
30
How would you manage a patient with high INR and a minor bleed?
Stop warfarin, IV vitamin K | +/- PCC/FFP depending on the situation
31
How much IV vitamin K should be given in high INR?
Minor bleed: 1-5mg | Major bleed 5-10mg
32
When should diltiazem not be used in patients with AF?
If there is concurrent heart failure and fluid retention
33
How is SVT managed?
Vagal manourvres Adenosine 6mg rapid IV bolus Try another 12 mg Try another 12mg
34
How do you manage fast AF?
If onset <48 hours: DC cardioversion Control rate with: B-blocker or diltizem (digoxin in HF) Anticoagulate
35
What would you give in stable VT?
IV amiodarone 300mg over 20-60min | Further 900mg over 24hrs
36
What would you give in a patient with tachycardia and features of shock?
DC shock x <3 | IV amiodarone
37
What is first line acute bradycardia management?
IV atropine
38
What is the antidote for benzodiazepine overdose?
Flumazenil
39
What is first line in organophosphate poisoning?
Atropine Oxygen Pralidoxime
40
How do you manage salicylate poisoning?
``` IV sodium bicarbonate Active cooling Activated charcoal if <1hr Haemodialysis Manage hypokalaemia ```
41
Which population of patients should not be prescribed pioglitazone?
Those with heart failure
42
What type of laxative is Senna?
Stimulant
43
What is the first line antibiotic in skin infections?
Flucloxacillin
44
What is the first line antibiotic in human or animal bites?
Co-amoxiclav
45
What is the key side effect of sulphonylureas (gliclazide)?
Hypoglycaemia | Should not miss meals
46
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
47
Which cancer risk is increased with combined HRT?
Breast
48
What is the added risk with oral HRT as opposed to transdermal?
Blood clots
49
What are the monitoring requirements for lithium?
Serum levels 12 hours after dose- target 0.4-1 (0.8-1 in acute mania)
50
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
51
What medications can be used to aid alcohol cessation?
Disulfiram: promotes abstinence (contraindicated in IHD and psychosis) Acamprosate: reduces cravings
52
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
53
What are the side effects of Amiodarone therapy?
``` Thyroid dysfunction Pulmonary fibrosis Bradycardia and long QT Liver fibrosis Photosensitivity Slate-grey appearance ```
54
How should carbon monoxide poisoning be managed?
100% oxygen | Hyperbaric oxygen
55
What are the key side effects of cyclosporin?
``` Gum hyperplasia Fluid retention Hyperkalaemia Hypertension Nephro and hepatotoxicity ```
56
What is first line management for most cocaine related problems?
Benzodiazepines
57
In which patients is diclofenac contraindicated?
``` ischaemic heart disease peripheral arterial disease cerebrovascular disease congestive heart failure asthmatics ```
58
What are common drug causes of urticaria?
aspirin penicillins NSAIDs opiates
59
What monitoring should be done when initiating statins?
Baseline LFTs | Again 3m, 12m
60
What monitoring should be done when initiating amiodarone?
TFT, LFT, U&E, CXR prior to treatment | TFT, LFT every 6 months
61
What bloods should be done before the initiation of sodium valproate?
LFT, FBC before treatment | LFT 'periodically' during first 6 months
62
Drugs causing lung fibrosis?
Amiodarone Methotrexate Nitrofurantoin Cytotoxic agents
63
What drugs cause photosensitivity?
``` Thiazides Tetracyclines, sulphonamides, ciprofloxacin Amiodarone NSAIDs e.g. piroxicam Psoralens Sulphonylureas Isotretinoin ```
64
What can be given to reverse heparin overdose?
Protamine Sulphate
65
For how long should women going through premature menopause be given HRT?
Until the age of 50
66
What are the common side effects of macrolide antibiotics?
``` QT prolongation Interaction with warfarin (P450 inhibitor) GI side effects Cholestatic jaundice Interaction with statins ```
67
How should methanol ingestion be managed?
fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol haemodialysis
68
What are the causes of oligogyric crisis?
antipsychotics metoclopramide postencephalitic Parkinson's disease
69
How is oligogyric crisis managed?
IV procyclidine
70
How would you manage TCA overdose?
IV bicarbonate | Dialysis
71
What would you give in cyanide poisoning?
Hydroxocobalamin; | also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
72
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)
73
What are potential side effects of PDE-5 inhibitors?
``` Blue tinge to vision Headaches Flushing GI side effects Priapism ```
74
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 ```
75
How is serotonin syndrome managed?
supportive including IV fluids benzodiazepines more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
76
What is a rare but important side effect of DPP4 inhibitors?
Pancreatitis
77
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
78
What are the side effects of rifampicin treatment?
Orange secretions | CYP450 inducer - reduced efficacy of medications
79
What are the side effects of isoniazid?
Peripheral neuropathy (prevent with pyridoxine) Hepatitis Agranulocytosis CYP450 inhibitor - increases medication availability
80
What are the side effects of pyrazinamide?
Hyperuricaemia causing gout Arthralgia/myalgia Hepatitis
81
What are the side effects of ethambutol?
Optic neuritis | Hepatic problems
82
How would you differentiate between serotonin syndrome and neuroleptic malignant syndrome?
Serotonin: hyperreflexia, myoclonus NMS: muscle rigidity, hyporeflexia
83
What are the potential side effects of sulphonylureas?
Hypoglycaemic episodes Increased appetite and weight gain Syndrome of inappropriate ADH secretion Liver dysfunction (cholestatic)

Finals Revision (23 decks)

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