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MRCP PART 1 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Orlistat class

A

pancreatic lipase inhibitor

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2
Q

Asprin in breast feeding risk of?

A

Reyes syndrome
bleeding problems

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3
Q

Quinolones (-floxacin) mechanism ?

A

Inhibit DNA Gyrase

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4
Q

aminoglycosides, and tetracyclines mechanism (gent / cyclines)

A

inhibit bacterial ribosomal protein synthesis

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5
Q

Penicillins action

A

binds to proteins -> impairs osmotic balance -> cell lysis

Cell wall synthesis

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6
Q

Cephalosporins action

A

bactericidal
Inhibit cell wall synthesis

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7
Q

How does metronidazole work

A

free radical production within anaerobic organisms

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8
Q

Aspirin overdose -> what blood gas initially? then? Pathophysiology of each

A

Respiratory alkalosis
[salicylates stimulate the respiratory drive ]

Followed by metabolic acidosis if severe
[due to disruption of ATP production -> anaerobic respiration and build-up of lactic acid ]

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9
Q

Why sub lingual drugs needed in lower doses

A

Avoid first pass metabolism

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10
Q

Carbamazepine’s key side effects

A

Cerebellar toxitiy
C for C in the brain

Hyponatraemia

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11
Q

Need co amox but amox allergy? What if preg?

A

Doxy + metro

Preg = Azithro + metro

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12
Q

Normal metabolism of paracetamol ? In OD?

A

conjugation to glucuronic acid
[NOT GLUTATHIONE]

in OD - pathway saturated so non specific P450 oxidation which produces toxic metabolite (NAPQI)
->NAPQI is conjugated by gluathione

If excess of NAPQI (glutathione saturated) then it binds to hepatocytes and causes cell death

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13
Q

Cardiac history - pt comes in complaining things have a weird colour or halo’s around. + nausea + anorexia + brady =?

A

Digoxin toxicity

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14
Q

Seen on ECG of therapeutic digoxin

A

Prolonged PR + scooped ST

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15
Q

Rx of digoxin toxicity? Key marker of mortality?

A

Fab fragments [digoxin specific antibody]

Potassium level >5

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16
Q

CP450 pneumonic

A

Bare minimum - remeber both mnemonics and the C in CRAPGPS is carbamazepine and s is sulphonylureas

Inducers - Reduces concentration of drugs) CRAP GPs
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas

Inhibitors (Increases concentration of drugs) SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

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17
Q

On multiple agents which increase QT why do die?

A

Torsade du pointes

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18
Q

Epilepsy with side effects:
Hair loss, liver damage, pancreatitis, weight gain?

A

Sodium valproate

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19
Q

Discoloured teeth in infants - what drug in preg?

A

Tetracyclines

TEETHracycline

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20
Q

Where do thiazide diruetics work on

A

The proximal segment of the distal convoluted tubule

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21
Q

Where do loop diuretics work?

A

Ascending loop of henle

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22
Q

Where do aldosterone antagonists work eg spironolactone

A

collecting duct

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23
Q

Where does amiloride work?

A

distal segment of distal convoluted tubule eNAC channels

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24
Q

Epilepsy and vision problems =

A

vigabatrin
V for vision

(loss of peripheral vision and retinal atrophy)
May also get alopecia and aggression

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25
Q

What happens in mdma toxiticy?

A

SIADH -> hypoNa

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26
Q

Key types of drug contra indicated with sildenafil?

A

Nitrates + nicroandil

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27
Q

Statins are HMG-CoA-reductase inhibitors? What does this mean? How does ezetimibe work?

A

Statins reduce cholesterol synthesis

Ezetimibe - reduces intestinal cholesterol absorption

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28
Q

How is lithium cleared

A

95% renal clearance
[none in liver]

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29
Q

How do PPIs work

A

inhibit H+/K+ATPase

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30
Q

Which antieileptic key for hypoNa

A

carbamazepine

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31
Q

Need to check before starting azathioprine therapy

A

TPMT

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32
Q

Drug of choice in hyperthyroid pregnancy

A

Propylthiouracil in first 2 trimesters
Often switched to Carbimazole before delivery

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33
Q

Vit D replacement levels in OP

A

400-800 units daily
[+1500mg Ca]

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34
Q

Who gets drug-induced lupus

A

White people

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35
Q

How does enox work?

A

potentiates action of anti-thrombin III

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36
Q

Diuretics class and where they act

A

MALT K

Mannitol (Osmotic Diuretics): water reabsorption in the proximal tubule

Acetazolamide (Carbonic Anhydrase Inhibitors): proximal tubule

Loop Diuretics: thick ascending loop of Henle, =/=> Na+/K+/2Cl- transporter (furosemide, ethacrynic acid)

Thiazides: distal tubule, =/=> Na+/Cl- symporter (hydrochlorothiazide, indapamide)

K+ sparing agents: distal nephron (late distal tubule + collecting ducts). Aldosterone receptor antagonist (spironolactone) Na+/K+ e
xchange by of Na+ channels (amiloride, triamterene)

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37
Q

Tricyclic OD key thing to give? 3 things worried about

A

IV Sodium Bicarbonate

Acidosis
Seizures
Arrhythmias

[50% chance of ventricular arrythmias with QRS >160ms)

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38
Q

Tricyclic OD key thing to give? 3 things worried about

A

IV Sodium Bicarbonate

Acidosis
Seizures
Arrhythmias

[50% chance of ventricular arrhythmias with QRS >160ms)

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39
Q

Oliguric crisis Rx

A

Procyclidine

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40
Q

Methanol poisoning rx mainstay if gubbed?drug? Mechanism?

A

RRT
Fomepizole - inhibitor of alcohol dehydrogenase

if mild and conscious -> try soda bic first

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41
Q

Where is methanol metabolised? Which is the metabolite which causes acidosis, blindness and end-organ damage?
Why could you give ethanol if no fomepizole?

A

Liver -> toxic metabolites
Formic acid [similar name to FORMepizole]

Ethanol competes with methanol (prevents toxic metabolite formation)

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42
Q

Drugs which cause lung fibrosis

A

Blah NeverMind

Bleomycin Nitrofurantoin MTX

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43
Q

Rifampicin action

A

RNA polymerase disruption

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44
Q

Diabetes and HGV licence

A

Need to discuss with DVLA if insulin dependent.
Need regular blood sugar checks when driving and before driving

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45
Q

When dialysis for methanol level?

A

Serum methanol >50mg/dl

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46
Q

Red urine and tears which drug

A

Rifampicin
Red Rif

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47
Q

HBA1C target? If on gliclazide or other drug which causes Hypos?

A

48mmol/mol

53

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48
Q

1st line for dual therapy T2DM if patient is obese?

A

DPP4 inhibitor
-gliptin

Or GLP-1
-Glutide

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49
Q

Which classes diabetic meds cause hypos (excluding insulin smart arse)

A

Sulphonyureas
-gliflozin (SGLT2 inhibitos)

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50
Q

Which antiepileptic - gum hypertrophy

A

Phenytoin

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51
Q

How does theophylline work?

A

Adenosine receptor blocker ->relaxation of smooth muscle

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52
Q

Key SE of bosentan (used for pulm HTN)

A

liver toxicity

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53
Q

What does finasteride do?

A

Prevents conversion of testosterone to dihydrotestosterone by inhibiting 5a-reductase

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54
Q

Drug for reducing prolactin in pituitary adenomas

A

Bromocriptine (dopamine agonist)

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55
Q

How does clomifene work

A

Stimulates pituitary release of GnRH

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56
Q

Green / blue urine from which infection? Which most common drug also causes it?

A

Pseudomonas

Amitriptyline

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57
Q

Long-term key risk of TNFa inhibitors

A

Lymphoma

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58
Q

How does amiodarone affect sight?

A

Corneal deposits

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59
Q

eg of aromatase inhibitor? Mechanism?

A

Letrozole, Anastrozole

Aromatase inhibitor
Blocks conversion of androgens -> oestrogens

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60
Q

Which antihypertensives bad with ciclosporin? Antibiotic?

A

Verapamil, diltiazem
Macrolides
[also imidazole based antifungals - good luck]

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61
Q

Who gets phenytoin toxicity even when drug in the normal range on bloods?

A

Uraemia
HypoAlbumin
Hyperbilirubin

[Get decreased phenytoin protein binding - drug appears to be in normal range but actually has more free non bound active bits in blood]

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62
Q

Who gets phenytoin toxicity even when drug in the normal range on bloods?

A

Uraemia
HypoAlbumin
Hyperbilirubin

[Get decreased phenytoin protein binding - drug appears to be in the normal range but actually has more free non bound active bits in blood]

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63
Q

Key side effect of donepezil

A

Cholinesterase inhibitor
->Brady most important

[Urine incontinence, hepatitis, GI upset]

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64
Q

Which NSAID most likely to cause convulsions in OD? What are symptoms of NSAID OD due to?

A

Mefanamic acid

Inhibition of cyclo-oxygenase

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65
Q

Why do you often get a little bit of hyperthyroid with reduced TSH pregnancy

A

B-HCG stimulates thyroid hormone production

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66
Q

how does carbimazole work

A

Converted to active metabolite - methimazole
-Inhibits iodination of tyrosine

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66
Q

how does carbimazole work

A

Converted to active metabolite - methimazole
-Inhibits iodination of tyrosine

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67
Q

First line antihypertensive if on lithium

A

Amlodipine

(ACEi can increase lithium levels)

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68
Q

How is propythiouracil different from carbimazole

A

Blocks peripheral conversion of thyroxine -> t3

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69
Q

Parkinsons drug which can be given S/C if no oral route

A

Apomorphine

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70
Q

Multiple fungal nails Rx

A

Oral Terbinafine
(topical only if 1 nail affected)

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71
Q

anti-emetics -setron’s are which class? Where do they work?

A

5HT-3 receptor antagonists
Medulla oblongata

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72
Q

Which parkinsons drug makes urine dark

A

L-dopa

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73
Q

Ciprofloxacin and a sore ankle whats happened

A

Ciprofloxacin induced achilles tendonitis

more likely if >60, on steroids, renal impairment or prev transplant/tendon rupture

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74
Q

How does NAC work in Paracetamol OD

A

Conjugates NAPQI as an exogenous glutathione source

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75
Q

3 main choices of Antihypertensive in pregnancy

A

Labetalol
Nifedipine
Methydopa

-Should also be prescribed aspirin

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76
Q

B Blocker OD Rx hypotension/brady? Hypoglycaemic?
Widened QRS?

A

IV glucagon - for symptomatic brady
-+/- Atropine, +/-isoprenaline

IV dextrose - if hypoglycaemic
Sodium bicarb for wide QRS or hypotension not fluid responsive

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77
Q

OD -> Hypo. Not diabetic drug

A

B blockers

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78
Q

Half life of adenosine? What drug increases this? When is it CI’d?

A

5s
Dipyridamole

May cause complete heart block in…
2/3rd degree heart block
Sick sinus syndrome
Verapamil

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79
Q

Which anti-epileptic is associated with osteomalacia? What on bloods would make you suspicious

A

Phenytoin

HypoCa, HypoVitD, HypoPO4
Raised ALP

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80
Q

Sulfonylureas mechanism and key side effects

A

stimulate insulin secretion by acting on the K+ ATP channel on the surface of the pancreatic β-cell

weight gain and risk of hypoglycemia

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81
Q

PPAR-γ agonists (thiazolidinediones)
Eg?
Mechanism?
Key side effects?

A

Pioglitazone
Act on adipose tissue to increase adipogenesis and lipogenesis in peripheral adipose depots.

Fluid retention -> Oedema / heart failure
risk of fractures

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82
Q

2 types of incretin class? EG?
Effect?
Side effects?

A

Oral (DPP-4) inhibitors (gliptins)
Injectable glucagon-like peptide-1 receptor agonists (GLP-1) -glutide

Stimulate glucose-induced insulin secretion
suppress glucagon production

Weight loss - mostly GLP-1 (good)
Risk of pancreatitis

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83
Q

SGLT2 inhibitors eg?
Mechanism?
Good for?
Key risks

A

-Gliflozin
Glycosuric suppress reabsorption of glucose from the proximal tubule

beneficial effects on major adverse cardiac even

UTIs / genital infections

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84
Q

Which diabetic drug may caused reduced gastric emptying

A

Gliptins

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85
Q

How do SLG2- inhibitors improve bp?

A

Osmotic diuresis

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86
Q

Which antidiabetic cause eDKA

A

SLG-2 inhibitors

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87
Q

Which class antidiabtics worst for fluid retention

A

-glitazones
(thiazolidinediones)

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88
Q

Medications causing erythema nodosum

A

Omeprazole
HepB vaccine
Isotrenatoin

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89
Q

drugs metabolised by CYP-2D6

A

Antidepressants - Tricyclic / SSRI
B blockers
c
Dihydrocodeine (converted to morphine)
Ecstasy

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90
Q

Dihydrocodeine but no analgesic effect?

A

Reduced CYP-2D6 action

[usually concerted to morphine]

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91
Q

Why take statins at night

A

HMG-CoA-reductase most active when fasting (and liver blood flow increased lying flat)

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92
Q

Which pain killer has actions on serotonin and may contribute to serotonin syndrome

A

Tramadol

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93
Q

What class is Phenelzine? what do you need to avoid

A

MAOi
SSRIs as risk of serotonin syndrome

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94
Q

Sumatriptan mechanis

A

5HT-1 agonist

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95
Q

hypertensive crisis and collapse Rx

A

IV Sodium nitroprusside

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96
Q

Hypokalaemic on furosemide - long term plan?

A

Add a potassium-sparing diruetic eg amiloride / spironolactone

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97
Q

What is aminophylline - how is it different in potency to theophylline

A

Theophylline + [ethylenediamine]
makes it 20x more potent

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98
Q

Key side effects of theophylline? in excess

A

Insomnia + agitation
[metabolic acidosis + hypoK]

OD -> profound hypoK and supraventricular arrythmias

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99
Q

Option for Rx of Kallman’s other than testosterone

A

Human Chorionic Gonadotrophin

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100
Q

How does trimethoprim work

A

Inhibits dihydrofolate reductase

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101
Q

What happens if you use allopurinol during an acute gout attack?

A

Prolongs and exacerbates episode

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102
Q

very low fibrinogen + bleed-> give what

A

Cryo
[Fibrinogen, VWF, VIII, XIII]

103
Q

What is the renal extraction ratio of a drug

A

The decline in plasma concentration from arterial -> venous section of kidney

104
Q

What is disodium cromoglycate used for? mechanism?

A

Asthma
Inhibits mast cell degranulation

105
Q

In a question - how might you work out which drug is the most water-soluble?

A

The ones which are lipid soluble will cross blood-brain barrier…

Eg Antidepressants, Acyclovir, benzos all need to be lipid soluble to get to brain

106
Q

Which antiepileptic for weight gain

A

Sodium valproate

107
Q

What will the question have if they want you to recognise severe CO poisoning?

A

Evidence of tissue ischemia
Eg -ST depression on ECG
-Raised lactate

108
Q

TB drug causing Visual issues / colourblind

A

Ethambutol

-E for Eyes

109
Q

Ciclosporin inhibts which IL

110
Q

What does warfarin inhibit

A

Factors 2,7, 9, 10
Protein C

111
Q

How does the POP work

A

Thickens cervical mucus
-> Sperm cannot enter

112
Q

What does ondansetron do to the 5-HAII receptors

A

Inhibits them

113
Q

Phenytoin OD sx

A

Agitation, Ataxia, nystagmus, drowsiness

114
Q

Abdo cramps, shivering, rhino/diarrhoea, tachy/hypertensive - features of withdrawal from?

115
Q

Malignant hyperthermia drug?

A

Dantrolene
[ryanodine receptor 1, and decreasing intracellular calcium concentration]
-> reduced muscle contraction

116
Q

Metformin mechanism

A

adenosine monophosphate-activated protein kinase agonist
[LOL WTF - mebe just ignore this]

117
Q

> 55 HTN didn’t tolerate amlodipine due to ankle swelling. Whats the next line?

A

Thiazide-like diuretic Eg indapamide / metolazone

118
Q

Mild allergy to penicillins (GI upset) and nitro-resistant bug in urine = what ABx in preg?

119
Q

Which cardio drugs do you need to avoid BBlockers in? Class ?

A

Verapamil / diltiazem
non-dihydropyridine calcium antagonist

120
Q

In whom might isoniazid cause more liver toxicity?

A

Rapid acetylator -> more toxic metabolites to liver

Slow acetylator would lead to higher drug concentrations and lead to systemic effects eg peripheral neuropathy

121
Q

Which antimalarial worst in G6PD

A

Primaquine

122
Q

Penicillamine adverse effects

A

Acute interstitial nephritis + pancytopenia

123
Q

Type A/B/C/D/E adverse drug reactions

A

A - Anticipated Eg Brady cardia from B blockers

B - Unexpected and unpredictable

C - Occur after prolonged use Eg peripheral neuropathy

D - Occur long after treatment finished Eg Cancer 20 years later

E - Due to withdrawal of drug

124
Q

Cisplatin key side effect bar nephro/ototoxicity

A

Peripheral neuropathy

125
Q

Why diarrhoea in metformin

A

Bile salt malabsorption

126
Q

Benzo remachanism

A

GABA Agonist

127
Q

3 ways which CKD alters drug pharmacokinetics

A

Gastric absorption
Protein binding
Volume of distribution

128
Q

Which Abx class risk of neuro Sx and chillies tendon rupture

A

Fluroquinolones - Eg Levofloxacin

129
Q

Bar nitrates what is the other ci to PDE-5 inhibitors

A

Coronary artery disease

130
Q

Key drugs affected by acetylator status

A

PISH’D
procainamide - Slow = drug induced lupus
isoniazid - slow = peripheral neurpathy, fast = liver toxicity
sulphonamides (especially salicylazosulphapyridine)
hydralazine - slow = drug induced lupus
Dapsone
[Nitrezepam]

131
Q

Want to start a mab in someone who has previously been treated for TB. What test do you do?

A

Interferon-gamma release assay

Positive test = current or latent infection which means need anti-TB drugs while getting -mab.

132
Q

In who is a mantoux test positive

A

Prev TB / BCG

133
Q

Ataxia and peripheral neuropathy which antiepileptic

134
Q

Gum hyperplasia and dupurytrens contracture which antiepileptic

135
Q

COX inhibitor (non-selective) Egs?
Selective COX-2 inhibitors?

A

Aspirin, NSAIDS eg diclofenac / nefopam

Celecoxib / rofecoxib

136
Q

What is hypertrichosis?

A

excessive hair growth
Eg cyclosporin

137
Q

Bosentan mechanism

A

Endothelin A+B receptor antagonist

138
Q

Endothelin A vs B fucntion

A

A - vasoconstriction of smooth muscle
B - Production of nitric oxide and prostaglandin

139
Q

Haemodialysis in lithium?

A

Level >6
Level > 5 and creatinine >150

Any level and decreased consciousness/life-threatening eg seizures

[If lithium naive and level >4]

140
Q

What is cisapride? Key risk

A

Prokinetic
QT prolongation
[Fatal arrhythmias if given with P450 inhibitors]

141
Q

Present with a stroke - hypertensive at the time (but not crisis). When should antihypertensive meds be started?

A

After 2 weeks
Or on hospital discharge

Risk of worsening cerebral ischemia if started immediately.

142
Q

Memantine mechanism

A

NMDA antagonist

[Not agonist]

143
Q

Amiodarone mechanism

A

Potassium channel blocker

144
Q

Sotalol mechanism

A

Selective B1 blocker
Potassium channel blocker

145
Q

Lidocaine mechanism

A

Sodium channel blocker

146
Q

How do CCBs work as an anti-arrhythmic

A

Delay AVN conduction

147
Q

Issue of graves and radioactive iodine

A

Worsens exophthalmos in first 3 months

148
Q

Strong predictor of bleeding when anticoagulated in alcoholics

A

AST/ALT ratio

149
Q

Withdrawal symptoms with hallucinations. Alcohol or benzo?

150
Q

2 examples of a thiazide-like diuretic when to use?

A

Indapamide, Chlotalidone, metolazone

CCB unsuitable in black / >55

151
Q

Posioning smells [wtf]
Eggs
Garlic
almonds
Mothballs

A

Eggs - hydrogen sulphide
Garlic - Arsenic / selenium
almonds - cyanide
Mothballs - Napthalene

152
Q

B1 vs B2 receptors

A

B1 - heart (one heart)
B2 - Lungs (2 lungs), vessels, GI….

153
Q

Buprinon used for?
Mechanism? 2 Key contraindications

A

Smoking cessation

inhibition of norepinephrine and dopamine reuptake

Cirrhosis
Seizures (reduces threshold)

154
Q

Trastuzumab other name? Mechanism it causes cardiomyopathy?

A

Herceptin
erb-B2 inhibitor

155
Q

Tiotropium class?

A

Long-acting anticholinergic (anti-muscarinic)

156
Q

Why are penicillins and glycopeptides (eg vanc) ineffective against chlamydia ?

A

Chlamydia lacks a cell wall

157
Q

2 protiens expressed by Ca cells which make them resistant to chemo

A

P-glycoprotein
Multidrug restiant protein

[accelerates eflux of toxic agents out the cells]

158
Q

What causes the dry cough with ACEi

A

Decreased Bradykinin breakdown

159
Q

Phaeo + HTN what drug for BP

A

A-blocker - Eg Phenylbenzamine [doxazosin]

160
Q

Dipyridamole class

A

Phosphodiesterase inhibitor

[-> upregulates cAMP -> blocks platelet response from ADP]

161
Q

Clopidogrel class? What does this do?

A

ADP inhibitor
Adenosine diphosphate receptor inhibitors

They prevent platelet aggregation by selectively and irreversibly binding the platelet surface receptor P2Y12

[These drugs antagonize the P2Y12 platelet receptors and therefore prevent the binding of ADP to the P2Y12 receptor.]

162
Q

Skin infection while breastfeeding

A

Still fluclox

163
Q

Glococorticoid induced osteoperosis Rx

A

Bisphosphonates

164
Q

Aspirin OD when would activated charcoal help

165
Q

Cardiac drug causing oral ulceration

A

Nicrorandil

166
Q

nicorandil mechanism? How many people get headaches

A

ATP dependent Potassium channel activator
35% get headaches

167
Q

Drugs that decrease digoxin secretion -> toxicity

A

verapamil, quinine, nifedipine and quinidine

168
Q

Entamoeba 1st line Rx?

A

Metronidazole

169
Q

Which antipsychotic 1st line for schitz and best re making them fat

A

Risperidone

170
Q

CN VI palsy caused by what class of Abx? why?

A

Tetracyclines -> intracranial hypertension

171
Q

Drugs causing intracranial HTN ? Withdrawal of what class does it as well?

A

Tetracyclines
Amiodarone
Oral contraceptive
Withdrawl of steroids

172
Q

Eculizumab is used for? Targets?

A

Paroxysmal nocturnal haematuria

Complement (C5)

173
Q

What links chlorpromazine, ciprofloxacin, ofloxacin, cimetidine, phenytoin, naproxen, captopril, erythromycin, azithromycin, and dicloxacillin.

A

Can cause obstructive jaundice

174
Q

If a question asks about which drug works through direct drug action rather than achieving effects through a metabolite how could you work it out?

A

The one that can go IV will work though direct action (probably)

175
Q

Imatinib is what

A

Tyrosine kinase inhibitor

176
Q

Hypersalivation and rhinorrheoa in what withdrawal

177
Q

TB - now significant interstitial nephritis - which drug?

A

Rifamipicin

178
Q

Which metal poisoning could you use penicillamine for?

A

Copper - Duh

179
Q

Thallium posioning Rx

A

Prussian blie

180
Q

Isolated thrombocytopenia cause
Rx?

A

ITP
Steroids if bleeding / platelets <20

181
Q

What is bioequivalance

A

Drugs have the same effect

181
Q

What is bioequivalance

A

Drugs have the same effect

182
Q

Trimethoprim severe side effect

A

Pancytopenia or agranulocytosis

183
Q

Bblockers and potassium

A

May cause hyperk RARELY

184
Q

Most common Abx causing obstructive jaundice

A

Co-amoxiclav (cholestasis)

185
Q

Enzymes insulin inhibits?

Activates?

A

Those in glucogenesis
Eg - Pyruvate carboxylase

Activates
Acetyl-CoA Carboxylase
ATP citrate lipase
G6PD

186
Q

Which Rheum DMARD would cause nephrotic syndrome (membranous glomerulonephritis)? Which HLA is assoc with this?

A

Penicillamine
[Or gold - rarely used]

Strong assoc with HLA DR3

187
Q

Why might you need to increase the dose of carbamazepine about 2 weeks after starting?
Ie initially therapeutic level then became sub-therapeutic

A

Autoinduction of CP450 -> increased metabolism

188
Q

Why do you not use alkaline solutions on acid burns

A

May cause heating / exacerbate injury

189
Q

Acid burns - what is the mechanism? What electrolyte disturbance is common after?

A

Skin coagulative and liquefactive necrosis through hydrolyzing of proteins

HypoCa

190
Q

Which cardiac med causes methaemoglobinaemia? What else might be seen on blood / film?

A

Nitrates
Cause Fe2+ (ferrous) -> Fe3+ (ferric)

Heinz bodies and haemolytic anaemia

191
Q

Heinz bodies mean what has happened?

A

indicative of oxidative injury to the erythrocyte

192
Q

Trimethoprim when breast feeding?
Cipro?
Doxy?

A

All good - the neural tube has developed now
Cipro BAD - tendon rupture in kids
Doxy bad - uptake into developing bones and tooth discolouration

193
Q

Paraquat (pesticide) OD kills you how?

A

Oxygen free radical toxicity

Acute alveolitis -> respiratory failure

If survives likle yo get pulm fibrosis

194
Q

Renal issue with amphotectin B

A

T1 RTA
-> HypoK

May also cause renal DI

195
Q

Meningitis contacts given

A

Cipro (oral )

196
Q

Methotrexate therapy - which common drug can affect clearance

A

Omeprazole

197
Q

Mpost importat part of vit A for sight

A

retinaldehyde

198
Q

UTI - given abx and now peripheral neuropathy?

A

Nitrofurantoin
[Nitro-Neuro]

may cause other neuro issues too eg optic neuritis / nystagmus / vertigo

199
Q

Cyanide antidote

A

Amyl nitrite

200
Q

Young woman vomiting post chemo 1st line rx

A

IV ondansetron

201
Q

Gitelmans - what long term diuretic for rx

A

K sparing Eg amiloride

202
Q

Rosuvastatin Key hepatic transporters

A

OATP1B1
BCRP

203
Q

Rosuvastatin Key hepatic transporters

A

OATP1B1
BCRP

204
Q

Why phenytoin levels fall slowly

A

Protein bunding 90% protein bound

205
Q

Tinnitus, dizziness, increased resp rate and sweating

A

Salcicilate OD

206
Q

Most common side effect of cyclophosphamide

A

Anaemia, neutropenia and thrombocytopenia

Hemorrhagic cystitis is quite rare - unless in high dose Eg Chemo

207
Q

new AF Rx. Now hepatotoxicity drug?

A

Amiodarone

208
Q

Antiepileptic causing PCOS

A

Sodium Valproate

[teratogenic and ovary smashing]

209
Q

3 main SEs of ciclosporin

A

Chronic interstitial nephritis
Hyperkalaemia
Hair grows (hypertrichosis)

210
Q

3 common drugs with a high first-pass metabolism - so used in caution in liver disease

A

Verapamil
Morphine
Propanolol

211
Q

Cranberry juice classically messes with which drug via which transporter?

Grapefruit?

A

Grapefruit - warfarin, ciclosporin and statin
-CYP3A4

Cranberry - Warfarin
-CYP2C9

212
Q

When lithium conc taken for routine testing? Therapeutic range

A

12 hours after dose
0.4-1mmol/L

213
Q

Big cause of postural hypotension in old people

A

Doxasisin most
[more than diuretics]

214
Q

Before Tb RIPE rx what needs to be assessed

A

Visual assessment

215
Q

Docetaxel mechanism

A

Bind to microtubules -> apoptosis

216
Q

Buserelin does what? mechanism

A

decreases androgen production
GnRH agonist
->increased levels then after few weeks of therapy testosterone levels fall

217
Q

Drug causes of gynaecomastia

A

DISCO

Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens.

218
Q

What are the COMMON side effects of olanzapine

A

Weight gain
Rise in LDL, Triglycerides, glucose

219
Q

Which antidiabetic - Short term insulin release when taken directly before meals ?
[For shift workers with periods of fasting]

A

Meglitinides
[Nateglinide, repaglinide]

220
Q

Why is domperidone better than metoclopramide

A

Does NOT cross the blood-brain barrier
-> doesn’t cause extrapyramidal side effects eg parkinsonism

221
Q

Amphotericin has lots of side effects including when administered - how is can these be reduced

A

Lipid bound preperation

222
Q

Where does haloperidol act for its antiemetic properties

A

Chemoreceptor trigger zone

223
Q

Which Abx most strongly assoc with steven johnsons

A

Co-trimoxazole (sulfonamides the bit causing the reaction]

224
Q

Azithromycin works how

A

Inhibits bacterial ribosomal protein synthesis
[MACROLIDES]

225
Q

Drug leading to blue vision

A

Sildenafil
[Blue pill in toilets]

226
Q

C diff no oral option best Rx ? Why

A

IV Metronidazole
-excreted into bile better than vanc

227
Q

Lead toxicity leads to vague Sx of anaemia, GI upset and…?
Rx?

A

Isolated nerve lesions Eg common peroneal
Oral DSMA or IV EDTA for chelation

228
Q

2 options for drug induced dystonia

A

Procyclidine
Benzatropine

229
Q

Indometacin mechanism

A

Inhibits prostaglandin synthase and COX

230
Q

which type of calcium channel do CCBs affect

231
Q

Tolterodine used for bladder instability is used why? Mechanism

A

Antimuscarinic
Specific to bladder - get less anticholinergic side effects

232
Q

Rosacea - given rx and develops blue-gray skin

A

Minocycline

233
Q

OD - unconcious with dilated pupils and tachycardia with ectopics

234
Q

Which diuretics decrease lithium concentration

A

Osmotic and
Acetazolamide
-> increase excretion

235
Q

Aspirin sensitivity syndrome Sx

A

Flushing, bronchospasm, urticaria

236
Q

Which Abx may cause drug induced autoimmune haemolysis? Parkinsons drug causing this?

A

Penicillin
Mdopa

237
Q

Abciximab is a

A

Glycoprotein2b3a inhibitor

238
Q

PPAR-a Example
PPAR-y example

A

a - fibrates (lower triglycerides and increase HDL)

y - glitazones

239
Q

Why GI bleed with NSAIDs

A

Depletes mucosal prostaglandin E levels

240
Q

On metformin, prescribed Abx -> goes to party gets MALA why

A

Alcohol
[metformin is renally excreted not affected by hepatic enzymes]

241
Q

Azathioprine inhibits …? Which means?

A

AzathioPRINE inhibits PuRINE synthesis
-> supresses lymphocytes

242
Q

Posoning with nerve agent eg sarin key effects?

A

Cholinergic [not anti]
Brady, sweating / salivation

Muscle fasicultions / tremor / neuro

243
Q

Why does verapamil need such a lower dose when given IV

A

Bioavailability
[high first pass metabolism]

244
Q

Nabilone is used in chemo - mechanism

A

Cannabinoid receptor agonist
[antiemetic]

Nabi - caNabinoid

245
Q

Previous pre-eclampsia. Preg again - rx?

A

Aspirin 75

246
Q

Which diuretic most leads to HypoNa and Hypok

A

Thiazides > furosemide

247
Q

CO poisoning in preg

A

Reduces oxygen dissociation from maternal to fetal Hb -> profound fetal hypoxia

248
Q

Drug causing parotid swelling

A

Propylthiouracil
Pp

249
Q

Why terlipressin in hepatorenal syndrome

A

Increases arterial vascular resistance -> reduces splanchnic hypovolemia
Decreases renin

250
Q

Antiemetic for motion sickness

A

Cinnarizine

251
Q

What is classed as very common side effect

A

Occurrs in >10%

252
Q

4-methylpyrazole mechanism

A

Its fomepizole
Competitive inhibitor of alcohol dehydrogenase

253
Q

methotrexate inhibits dihydrofolate reductase. But what does this mean for rheum A

A

leads to reduced purine synthesis

MRCP PART 1 (22 decks)

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