Pharmacology Flashcards
How do you work out a breakthrough dose from someones maintenance dose?
Morphine breakthrough is 1/6 of the maintenance
How do you convert oral to SC/IV/IM morphine?
Divide by 2
How do you convert Oral to SC Diamorphine
Divide by 3
How do you convert oxycodone to SC Diamorphine?
Divide by 1.5
Examples of Quinolones?
Levofloxacin
Ciprofloxacin
When should quinilones be avoided?
Breast feeding and G6PD deficiency
Epilepsy
What is Diclofenac contraindicated in?
Any CDV disease
What medication can affect your Glucose Tolerance?
Thiazides
Common side effect of Colchicine
Diarrhoea
If someone is allergic to aspirin what else are they likely to be allergic to?
Sulphasalazine
Buproprion Contraindications - Smoking cessation drug
Reduces Seizure Threshold
Not safe in pregnancy
List of Critical Medications that should be given in severely unwell patient.
Anticholinesterases Anti Epileptics Anti coagulants Corticosteroids Diabetic Medication Bronchodilators Parkinson disease medication
What opiod can be used in Neuropathic Pain
Tramadol
When do you check gentamicin levels?
Peak - 1 Hour after administration
Trough - Just before next dose
If gentamicin peak levels are found to be high what is done?
Reduce dose of gentamicin prescribed
If trough Gentamicin levels are found to be high what is done?
Prolong interval between doses
When is gentamicin contraindicated?
Myasthenia Gravis
Renal Failure
What Biologics are used in Crohns and Rheumatoid Arthritis
TNF alpha inhibitors
Adalimumab
Infliximab
Etanercept
What biologics are used in Glioblastomas, Colorectal cancers and renal cancer?
Anti VEGF
Bevacizumab
What Biologics are used in CML and GI Stromal Tumours?
Tyrosine Kinase Inhibitors
Imatinib
What biologics are used in renal transplants?
IL2 binders
Basiliximab
In EGF +ve Colorectal cancer what biologics can be used?
Epidermal Growth Factor Inhibitors
Cetuximab
Rifampicin
Liver enzyme inducer
Orange secretions
Hepatitis
Isoniazide
Liver enzyme inhibitor
Peripheral neuropathy
Pyrazinamide
Gout
arthralgia
myalgia
Ethambutol
Optic neuropathy
When do you check phenytoin and cyclosporin levels?
Before next dose
When do you check lithium levels?
12 hours after dose
When do you check digoxin levels?
6 hours after
ACEi - side effects
Cough
Hyperkalaemia
Thiazide side effects
Gout Hypokalaemia Hyponatraeia Impaired glucose tolerance Hypercalcaemia
Ca channel blockers - side effects
Headache
Flushing
Ankle oedema
Beta Blockers - side effects
bronchospasm
fatigue
cold peripheries
PPI side effects
Hypomagnesia
Increase risk of C.difficile
How long should a PPI be stopped prior to a endoscopic investigation for dyspepsia?
2 weeks
Lithium toxicity - Stop these DAMN
Diuretics
ACEi/ARB
Metronidazole
NSAIDS
AKI - Stop these medications DAMN
Diuretics
ACEi/ARB
Metformin
NSAIDs
How often are lithium levels monitored?
Weekly until levels stabilise
If dose changes they are again monitored weekly until levels stabilise.
If someones eGFR is below 10 what pain medication can they receive?
Fentanyl
Afentanyl
Buprenorphine
If someones eGFR is between 50 - 10. What pain killers can they receive?
Oxycodone
Someone on a retinoid needs to be on what?
2 forms of contraception
Side effects of retinoids
Commonest is dry skin Increased triglycerides Hair thinning Increased intracranial pressure Photosensitivity Low mood
Side effects or contraindications for triptans
Tight chest and throat
Avoid with SSRIs
Sulfonamides allergy
Avoid in any CDV disease
What blood tests are required before terbinafine. Used for fungal nail resistant to topical treatment?
LFT before and 4-6 weeks into treatment
Nitrofurantoin affect on the lungs
Fibrosis
If someone is on clopidogrel what PPI should they be on?
AVOID omeprazole
Lansoprazole is first choice
What anti hypertensive can cause constipation
Calcium Channel blockers
What psychology medication can cause a benign leucocytosis
Lithium
Which anti angina medication is linked to ulceration within the GI tract?
Nicorandili
Management of MRSA
Vancomcin -> teicoplanin -> Linezolid
What affect can heparin have on U + Es?
Hyperkalaemia
What do all controlled drug prescriptions require?
name and address of the patient
the form, and where appropriate the strength, of the preparation - either the total quantity (in both words and figures) of the preparation, or the number (in both words and figures) of dosage units to be supplied the dose (cannot write 'as directed')
prescribers name, signature, address and current date
What must be done prior to starting Amiodarone?
LFT - as causes liver cirrhosis and fibrosis
TFT - causes thyroid dysfunction
U and Es - MOA is blocks K+ channel
Chest X ray - causes lung fibrosis and pneumonitis
Some side effects of amiodarone
Pulmonary fibrosis, Liver cirrhosis, peripheral neuropathy, slate grey appearance, thyroid dysfunction, thrombophlebitis at sight of administration
Side affects of cyclosporin
Everything is increased
What is phenytoin linked to
Peripheral Neuropathy
When do corticosteroids need to be withdrawn gradually ?
> 40mg daily for 1 week
3 weeks treatment
Repeated course recently
Steroids affect on a FBC
Can cause a neutrophilia
Medication linked causing pancreatitis
Azathioprine Mesalazine Bendroflumethiazide Furosemide Steroids Sodium Valproate
Lithium Monitoring
Dose checked 12 hours post dose - target 0.4 -1.0
Initial - levels checked weekly until levels stabilise
Established - levels checked every three months
- U and Es + TFT checked every 6 months
Altering dose - levels checked weekly until levels stabilise
Lithium Toxicity
> 1.5mmol toxicity starts
Coarse tremor, hyperreflexia, confusion, polyuria, seizure, coma
Mild to moderate - fluid resus with normal saline
Severe - haemodialysis
Lithium side effects
Fine tremor Hyperparathyroidism and Hypercalcaemia Nephrotoxicity ECG - T wave flattening Leucocytosis Idiopathic Intracranial Hypertension
Thiazide side effect
Altered OGTT Hypokalaemia Hyponatraemia Hypercalcaemia Pancreatitis Erectile dysfunction Postural hypotension Dehydration Agranulocytosis Thrombocytopenia
What affect can chloramphenicol have if taken during pregnancy or whilst breastfeeding.
Grey baby syndrome
Decreases sperm count
Sulphasalazine
Someone on an SSRI + NSAID should also be on?
PPI for gut protection
DOACs and there predominant method of excretion
Apixiban = GI aPOOxiban Riveroxaban = Liver liveroxaban Dabigatran = Renal Dabigatrenal
How does loperamide work?
reduces gastric motility by stimulating opioid receptors
What affect does trimethropin have on the acid base balance
Can cause Type 4 renal tubular acidosis
Avoid if on ARB or K+ sparing diuretic
What monitoring is undertaken in statins?
LFT baseline and at 3 and 12 months
Red man syndrome is associated to which antibiotic
Vancomycin