Pharmacology Flashcards
95 Year old Male patient with COPD … Confusion / hallucination and delusion
Prednisolone (high dose / systemic tx)
Corticosteroid induced Psychosis (cause psychiatric reaction )
within a few days to weeks of starting tx
Must-Know adverse effect of some drugs
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.
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?
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.
Pt on long term Warfarin
What need to be reported
Most Alarming SE
Headaches and Abdominal pain
Most alarming ICH
GI bleedings
Insomnia / Lumbar disc herniated / DM HT ive pt with Standing up Drop in BP >20mmhg
which drug to stop
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
Hepatic Enzyme Inhibitors
Now they have no effect on OC pills
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 )
OC pills most feared enzyme INDUCERS
Rifampicin Anti Convulsants (Phenytoin Phenobarbitone Carbamazepine )
Contraceptive methods not effected by Enzyme inducing drugs
Progesterone only containing drug (Depo Provera )
LNG- IUS (Levonorgestrel containing ) (Synthetic Progesterone )
Copper IUD
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 )
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»_space;> LN-IUS or IUCD ( both UKMEC 2)
your choice will depend on the question information and clues.
N acetyl cysteine
NAC
••Decrease free radicals by increasing Glutathione production (antioxidant)
••Decrease inflammation by decreasing cytokines
••Decrease mucous by breaking Sulfhydryl bonds
Pt started on Ramipril
Blood for CP is good
what to do next
Renal function test in 2 weeks
ACE: A : Angioedema C: cough E: Elevated potassium
Type 1 DM patient with AGONISING burning pain in his ankle / ulcer
Uncontrolled DM
what to give for PAIN (NEUROPATHIC)
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.
Side effect of Co amoxiclav
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
Liver Enzymes
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 ?
Ring infection of the skin
FUCIDEN given
not relieved by 1 week
what to give
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
Urine positive for Myoglobin after taking Anti hypertensive and DM drugs
Ck = 3080
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
Clarithromycin interaction with other drugs
C + Simuvistatin = Rhabdomylosis
C + Salbutamol = Hypokalemia
C + Methadone = QT interval prolongation
-HAIR LOSS SIDE EFFECTS DRUGS:
W-COALS WARFARIN. Cocp & Chemo. Oestrogen (HRCT). ACE. Lithium. Sodium Valproate
Oestrogen - Hair Loss
Spironolactone - Gynaecomastia / Use for tx of Hair loss
Short term Side effects Steroids
short term oral steroids=
SLEEPLESSNESS
restlessness,
indigestion…..
Thrush caused by Inhaled CS
Sexual Dysfunctional Drugs
- FLUOxetine stops FLOw of sperm ..that’s its causes inability to ejaculate.
- HALoperidone HALts erection…that’s erectile dysfunction.
- RESperidone causes RETrograde ejaculation.
End of live care
Seizures
which medicine
IM route is contraindicated
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
POP Emergency contraceptive Pills
POP inhibits POPPING(ovulation) of ova
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
Clarith + Warfarin: Increased INR
Clarith + Statin: Rhabmyolosis
Clarith + Salbutamol: Hypokalemia
Clarith + Methadone: QT Prolonged
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
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
Hyperthyroid Patient started on Carbimazole
Most dangerous side effect
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
PH 1110 Poly pharmacy
5 or more durgs
antihypertensive drugs of different groups
antipsychotic medications
Drug adjustment needed in Smoking person
be aware of a small number of drugs, in particular, \
aminophylline(smoking increased clearance),
theophylline(smoking increased clearance),
clozapine, olanzapine, TCAs
Useful mnemonic for some of the TB medications
: Ethambutol —- Eye side effect Refampicine —- Red discoloration of body secretion Pyrazinamide (as thiazide )—- Hyperuricaemia
Old patient chronic RA
Develops dyspnea
cxr pulmonary interstitial infiltrates
what is the causative drug
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
Cessation drugs
ALCOHOL=DISULFIRAM
OPIOIDS= METHADONE
SMOOKING=BUPROPION
IF an elderly frequently falls and is on Anti depressant and Anti psychotics
which one
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
Anti folate medications
Metho Trexate
Tri methoprim
Meniere BPPV Vestibular Neuritis
Vertigo
Buccal Prochlorperazine
Meniere BPPV Vestibular Neuritis
Vertigo
Buccal Prochlorperazine
First convert all to Oral Morphine
then calculate
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
Lidocaine dose calculation
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
before commencing Amiodarone
before lithium
Serum electrolytes and urea
Thyroid function test / Renal function test
Hypokalaema
thidzide / loop
Vomiting diarrhoea
Renal tubular failure
Villous adenoma
Hypokalaema
thidzide / loop
Vomiting diarrhoea
Renal tubular failure
Villous adenoma
Cushing Conn’s disease
Hyperkaliemia
ACE inhibitors
Addison
Congenital Adrenal Hyperplasia
Potassium sparing ( Spironolactone / Eplerenone / Amiodarone / Triamterene
PH 3450 3450
Elderly hypotension
due to ACEI or Zopiclone (drug for insomnalance )
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
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.
⏭️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.
