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Plab Hla Myint Aung > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

95 Year old Male patient with COPD … Confusion / hallucination and delusion

A

Prednisolone (high dose / systemic tx)
Corticosteroid induced Psychosis (cause psychiatric reaction )
within a few days to weeks of starting tx

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2
Q

Must-Know adverse effect of some drugs

A

Thiazides (Diuretic) ::– -
Hyponatremia - Hypokalemia - Hypotension (postural)
- Hyperuricemia /Gout - Hyperglycemia (>DM patients)

LOOp Diuretics (Furosemide)::– -
Hyponatremia - Hypokalemia - Gout

POtassium-sparing Diuretic (SpirOnOlactane)::– -
Hyponatremia - Hyperkalemia (>K+) - GynaecOmastia

Folic-acid Deficiency — -
Angular stomatitis and Anaemia.

  • Methotrexate (anti-folic acid)* — - Pulmonary fibrosis - Cough, Dyspnoae, Fever.
  • SSRI (Fluoxetine)* — - Hyponatremia /
  • ACE-i (Ramipril n others)* – - Angioedema - Cough - Electrolytes (K+) - Increased electrolytes
  • Pulmonary fibrosis* – - Amiodarone, Busulphan, Bleomycin, Carbagoline, Gold, Methotrexate, Nitrofurantoin, Sulfasalazine.
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3
Q 
Patent with Diarrhoea for 7 times within 24 hours 
Taking durgs for HT losartan 
DM Metformin 
Serteline 
GFR > 60 
but Urea and Creatinine high what to do?
A

If Diarhea ..
Stop/ reduce DAMN
(Diuretics, ACEIs/ARBs, Metformin, NSAID)

Losartan (ARB) stopped so that
Aldosterone can act on renal efferent arteriole and cause vasoconstriction which
improves glomerular perfusion and thus increased excretion of Urea and Creatinine.

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4
Q

Pt on long term Warfarin
What need to be reported
Most Alarming SE

A

Headaches and Abdominal pain

Most alarming ICH
GI bleedings

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5
Q

Insomnia / Lumbar disc herniated / DM HT ive pt with Standing up Drop in BP >20mmhg
which drug to stop

A

definition of orthostatic hypotension
fall in SBP of 20 mmHg ( 30 mmHg in hypertensive Pt) and or fall in DBP of 10 mmHg within 3 minutes of standing.

Stop Ramipril

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6
Q

Hepatic Enzyme Inhibitors

Now they have no effect on OC pills

A

Azithromycin is a hepatic enzyme inhibitor drug!

One must know that the contraceptive pills are less effective with hepatic enzyme inducers medicine;

CRAP GPs 
Carbamazepine, 
Rifampicin, 
Alcohol, 
Phenytoin, 
Griseofulvin, 
Phenobarbitone 
sulfonylurea. (Glipizide )
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7
Q

OC pills most feared enzyme INDUCERS

A 
Rifampicin
Anti Convulsants (Phenytoin Phenobarbitone Carbamazepine )
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8
Q

Contraceptive methods not effected by Enzyme inducing drugs

A

Progesterone only containing drug (Depo Provera )
LNG- IUS (Levonorgestrel containing ) (Synthetic Progesterone )
Copper IUD

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9
Q

Girl taking Carbamazepine
which Contraception

IUD AND IUS 20 years = UKMEC 1 (the best )
IUD AND IUS < 20 year = UKMEC 2 (Benefits > Risks Osteoporosis in depo progesterone only implant )

A

Girl = or > 18 years with REGULAR BLEEDING - Progesterone (Depo provera)

if the Pt on carbamazepine and is > or = 18 choose depo provera bcz it is UKMEC 2 .

if 18 and with irregular bleedings choose&raquo_space;> LN-IUS or IUCD ( both UKMEC 2)

your choice will depend on the question information and clues.

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10
Q

N acetyl cysteine

A

NAC
••Decrease free radicals by increasing Glutathione production (antioxidant)
••Decrease inflammation by decreasing cytokines
••Decrease mucous by breaking Sulfhydryl bonds

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11
Q

Pt started on Ramipril
Blood for CP is good
what to do next

A

Renal function test in 2 weeks

ACE: A : Angioedema C: cough E: Elevated potassium

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12
Q

Type 1 DM patient with AGONISING burning pain in his ankle / ulcer
Uncontrolled DM
what to give for PAIN (NEUROPATHIC)

A

NICE guidelines:

Offer a choice of
amitriptyline,

duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain
(except trigeminal neuralgia).

For trigeminal neuralgia, the drug of choice is carbamazepine.

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13
Q

Side effect of Co amoxiclav

A

Drug induced hepatitis AST and ALT markedly raised.

Cholestatic hepatitis ALP raised more than others. (SE of Co amoxiclav )

ViraL hepatitis ALT markedly raised

Alchohol(SpiritS) hepatitis AST markedly raised

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14
Q

Liver Enzymes

A 
ALT = Liver specific 
AST = Smooth muscles + Cardiac + Liver  (If Muscle origin CK will be raised )
ALP = Raised when Cholestatic or Obstruction in the HEPATOBILLARY TRACT / Also Raised in BONE Diseases and Vit D 
P = IN Burmese PATE NAY LO

GGT = Liver Pancreas Kidney Prostate BUT NOT IN THE BONE
Used to differentiate if RAISED ALP is from LIVER or BONE ?

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15
Q

Ring infection of the skin
FUCIDEN given
not relieved by 1 week
what to give

A

FUCIDEN is antibacterial cram - Do not work on fungal
Ring worm infection = Antifungal (Clotrimazole )

antibacterial didnt work, looks like fungal infection. do not give steroid

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16
Q

Urine positive for Myoglobin after taking Anti hypertensive and DM drugs
Ck = 3080

A

Simvastatin = Rhabdomyolysis
CK > x10 times with Myoglobin in urine
/ Uncommon complication
CK> 2000 up to 10000 in severe cases

Not to be given together with Amiodarone and Clarithromycin which inhibit the breakdown of STATINS

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17
Q

Clarithromycin interaction with other drugs

A

C + Simuvistatin = Rhabdomylosis
C + Salbutamol = Hypokalemia
C + Methadone = QT interval prolongation

18
Q

-HAIR LOSS SIDE EFFECTS DRUGS:

A 
W-COALS 
WARFARIN. 
Cocp & Chemo. 
Oestrogen (HRCT). 
ACE. 
Lithium. 
Sodium Valproate

Oestrogen - Hair Loss
Spironolactone - Gynaecomastia / Use for tx of Hair loss

19
Q

Short term Side effects Steroids

A

short term oral steroids=

SLEEPLESSNESS
restlessness,
indigestion…..

Thrush caused by Inhaled CS

20
Q

Sexual Dysfunctional Drugs

A
  1. FLUOxetine stops FLOw of sperm ..that’s its causes inability to ejaculate.
  2. HALoperidone HALts erection…that’s erectile dysfunction.
  3. RESperidone causes RETrograde ejaculation.
21
Q

End of live care
Seizures
which medicine
IM route is contraindicated

A 
Rectal Diazepam (More preferred because cheap)
Buccal Midazolam

he is being discharged from the hospital ….
so ofcourse only either
buccal/ per-rectal …..
nobody can give IV @ home - only administered in hospital

22
Q

POP Emergency contraceptive Pills

A

POP inhibits POPPING(ovulation) of ova

23
Q

If you see Warfarin In a stem
if the ask ask for adverse eff that can happen = Choose Headache *(ICH)
If drug interaction enzyme inhibitors also think of ICH

A

Clarith + Warfarin: Increased INR
Clarith + Statin: Rhabmyolosis
Clarith + Salbutamol: Hypokalemia
Clarith + Methadone: QT Prolonged

23
Q

PH 7001
If you see Warfarin In a stem and Co Dydramol
if the ask ask for adverse eff that can happen = Choose Headache *(ICH)
If drug interaction enzyme inhibitors also think of ICH

A

An interaction between warfarin and acetaminophen( from co-dydramol ) may result in significant elevations of international normalized ratio (INR), putting patients at increased risk for hemorrhagic complications

24
Q

Hyperthyroid Patient started on Carbimazole

Most dangerous side effect

A

Agranular cytosis (Neutropenia )
Agranulocytosis (dangerously low number of white blood cells, presents with sore throat and flu-like fever)
Monitor FBC ✅ Other drugs include: Cloazpine

Neutropenia : Clozapine, Carbimazole, Chemotherapy

25
Q

PH 1110 Poly pharmacy

5 or more durgs
antihypertensive drugs of different groups
antipsychotic medications

A
26
Q

Drug adjustment needed in Smoking person

A

be aware of a small number of drugs, in particular, \

aminophylline(smoking increased clearance),
theophylline(smoking increased clearance),

clozapine, olanzapine, TCAs

27
Q

Useful mnemonic for some of the TB medications

A

: Ethambutol —- Eye side effect Refampicine —- Red discoloration of body secretion Pyrazinamide (as thiazide )—- Hyperuricaemia

28
Q

Old patient chronic RA
Develops dyspnea
cxr pulmonary interstitial infiltrates
what is the causative drug

A

Methotrexate which is an anti-folic acid drug can cause some side effects like GI upset ,
Angular stomatitis and anemia due to folic acid deficiency but

the most feared one is pulmonary fibrosis but fortunately it is a rare SE .

regarding hydroxychloroquine the side effect that we fear is visual loss from retinopathy so eyes examination is mandatory
every 6 months in patients taking it for RA

29
Q

Cessation drugs

A

ALCOHOL=DISULFIRAM
OPIOIDS= METHADONE
SMOOKING=BUPROPION

30
Q

IF an elderly frequently falls and is on Anti depressant and Anti psychotics
which one

A

SNRI - Duloxetine cause Postural hypotension and hyponatremia

Atypical Antipsychotics - Clozapine causes Postural Hypotension

If the stem contain both of them and HYPONATREMIA choose Duloxetine

If only postural hypotension choose Clozapine

31
Q

Anti folate medications

A

Metho Trexate

Tri methoprim

32
Q

Meniere BPPV Vestibular Neuritis

Vertigo

A

Buccal Prochlorperazine

32
Q

Meniere BPPV Vestibular Neuritis

Vertigo

A

Buccal Prochlorperazine

33
Q

First convert all to Oral Morphine

then calculate

A

oral morphine 1)
injectable morphine -1/2

2) injectable diamorphine - 1/3
3) 10 times tramadol

Here if they asked oral morphine it would be 600/10 that is 60mg

but the stem mentioned dose of subcutaneous morphine that is
(injectable morphine 1/2) which will be 60 /2 = 30mg

34
Q

Lidocaine dose calculation

A

1% lidocaine solation = 1 g in 100 ml = 1000 mg in 100ml = 10mg in 1ml

Question will ask 10ml is used
body weight is 4mg per kg and it is 50kg
4 x 50 = 200mg

10mg = 1ml
200 mg = 20 ml

so 20 - 10 ml = 10ml

35
Q

before commencing Amiodarone

before lithium

A

Serum electrolytes and urea

Thyroid function test / Renal function test

36
Q

Hypokalaema

A

thidzide / loop
Vomiting diarrhoea
Renal tubular failure
Villous adenoma

36
Q

Hypokalaema

A

thidzide / loop
Vomiting diarrhoea
Renal tubular failure
Villous adenoma

Cushing Conn’s disease

37
Q

Hyperkaliemia

A

ACE inhibitors
Addison
Congenital Adrenal Hyperplasia
Potassium sparing ( Spironolactone / Eplerenone / Amiodarone / Triamterene

38
Q

PH 3450 3450

Elderly hypotension
due to ACEI or Zopiclone (drug for insomnalance )

A

Compare the sitting and standing blood pressure in the stem
IF there is a significant difference there is postural hypotension
()
orthostatic hypotension fall in SBP of 20 mmHg ( 30 mmHg in hypertensive Pt) and or fall in DBP of 10 mmHg within 3 minutes of

39
Q

Doxycycline and Bisphosphonates

when doxycycline pass the Esophagus / the drug can casue oesophegal ulcers
take a plain glass of water after ingestion of the capsule for specially avoiding the notorious oesophageal ulcer.

A

⏭️1. Doxycycline is to be taken with a glass full of water and with meal as it can cause oesophagits/ulcers, nausea and vomiting.

Also, anything with positve ions eg Ca+, Mg+, Fe+ shouldn’t be taken with Tetracycline as they reduces absorption of tetra.

⏭️2. Bisphosphonates is to be taken before meal and taken upright position. B before M.

Plab Hla Myint Aung (29 decks)

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