Pharmacology

Question 1

What are the side effects of amiodarone?

Answer 1

1. thyroid dysfunction: both hypothyroidism and hyper-thyroidism
2. corneal deposits
3. pulmonary fibrosis/pneumonitis
4. liver fibrosis/hepatitis
5. peripheral neuropathy, myopathy
6. photosensitivity
7. ‘slate-grey’ appearance
8. thrombophlebitis and injection site reactions
9. bradycardia
10. lengths QT interval

Question 2

Which drugs are CYP inducers?

Answer 2

CRAP GPS

1. Carbamazepines
2. Rifampicin
3. Alcohol
4. Phenytoin
5. Griseofulvin
6. Phenobarbitone
7. Sulphnylureas

Question 3

Which drugs are CYP inhibitors?

Answer 3

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1. Sodium valporate
2. Isoniazid
3. Cimetidine
4. Ketoconazole
5. Fluconazole
6. Alcohol
7. Chloramphenicol
8. Erythromycin
9. Sulfanamides
10. Ciprofloxacin
11. Ompeprazole
12. Metronidazole
13. Grapefruit juice

Question 4

What class of mediciations can cause a black hairy tongue?

Answer 4

Tetracyclines

e.g. doxycycline

Question 5

What should you do if you suspect digoxin toxicity?

Answer 5

Stop digoxin and repeat concentration within 8-12 hours of the last dose and review

Question 6

What is a common side effect of a vancomycin infusion?

What is the treatment for this?

Answer 6

Red man syndrome

Stop the infusion nad restart at a slower rate

Question 7

What medication can cause a megoblastic anaemia?

How does it do this?

Answer 7

Phenytoin

Altering folate metabolism

Question 8

What is the most common side effect of metformin?

Answer 8

GI - diarrhoea/bloating

Question 9

What are the first line treatmenets for opioid detoxification?

Answer 9

Methadone or buprenorphine

Question 10

What is the most important perameter to monitor in paracetamol overdose?

Answer 10

Aterial blood gas pH

Question 11

If a patient has unpleasent side effects of metformin what can it be changed to?

Answer 11

Try modified-released formulation

Question 12

How does a statin work?

Answer 12

Inhibits HMG-CoA reductase, the rate-limiting step in cholesterol synthesis

Question 13

What drugs should be stopped in AKI as they may worsen kidney function?

Answer 13

1. NSAIDs (except if aspirin at cardiac dose e.g. 75mg od)
2. Aminoglycosides
3. ACE inhibitors
4. Angiotensin II receptor antagonists
5. Diuretics

Question 14

What drugs are folic acid inhibitors therefore should not be prescribed together?

Answer 14

Methotrexate

Trimethoprim

Question 15

What drug might caused an abormal BNP measurement?

Answer 15

ACE inhibitors, ARB and diuretics

Question 16

What is a side effect of adenosine?

Answer 16

Chest pain

Question 17

What is the treatment for a bezodiazepine overdose?

Answer 17

1. Flumazenil
2. The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.

Question 18

What is the treatment for beta blocker overdose?

Answer 18

1. if bradycardic then atropine
2. in resistant cases glucagon may be used

Question 19

What is the management of methanol poisoning?

Answer 19

1. fomepizole or ethanol
2. haemodialysis

Question 20

What is the management of a tricyclic antidepressant overdose?

Answer 20

1. IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
2. arrhythmias: class 1a (e.g. Quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation. Class III drugs such as amiodarone should also be avoided as they prolong the QT interval. Response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in management of tricyclic induced arrhythmias
3. dialysis is ineffective in removing tricyclics

Question 21

What is the management of a salicylate overdose?

Answer 21

1. urinary alkalinization with IV bicarbonate
2. haemodialysis