Pharmacology

Question 1

Simvastatin MOA

Answer 1

inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis

Question 2

Broad complex tachycardia Mx

Answer 2

stable - amiodarone
unstable - DC cardioversion

Question 3

Regular Narrow complex tachycardia Mx

Answer 3

1st - vagal manoeuvre
2nd - adenosine
3 - B Blocker
if unstable - DCCV

Question 4

Irregular narrow complex tachycardia Mx

Answer 4

<48hours - Cardiovert (DC/ Chemical)
B Blocker - rate control

Question 5

Bradycardia Mx

Answer 5

1 - atropine 500mg IV (up to 3mg)
2 - transcutaneous pacing
3 - isoprenaline/ adrenaline

Question 6

Chronic Heart failure Mx

Answer 6

1 - ACEi/ ARB + B Block
2 - Aldosterone antagonist (spironolactone/ eplerenone)
Extra: annual influenza vaccine, one-off pneumococcal vaccine

Question 7

Post ACS long term Mx (secondary prevention)

Answer 7

DAPT (inc Aspirin)
ACEi
beta-blocker
statin

Question 8

Ca Channel Blocker SE

Answer 8

headache, flushing, ankle oedema

Question 9

paracetamol OD Mx

Answer 9

activated charcoal if <1hr ago
n-acetylcysteine
liver transplant

Question 10

salicylate (aspirin) OD
Fx
Mx

Answer 10

Fx - hyperventilation, tinnitus
Mx - IV Bicarbonate, haemodialysis

Question 11

Benzodiazepines OD Mx

Answer 11

Flumazenil

Question 12

Tricyclic antidepressants OD Mx

Answer 12

IV Bicarbonate

Question 13

Lithium OD Mx

Answer 13

haemodialysis

Question 14

Warfarin OD Mx

Answer 14

Vit K, prothrombin complex

Question 15

Heparin OD Mx

Answer 15

protamine sulphate

Question 16

B blocker OD Mx

Answer 16

1st atropine
2nd glucagon

Question 17

Ethylene glycol (anti freeze) Od Mx

Answer 17

fomepizole

Question 18

Organophosphate insecticide OD Mx

Answer 18

atropine

Question 19

Digoxin OD Mx

Answer 19

Digoxin specific antibodies

Question 20

Iron OD Mx

Answer 20

Desferrioxamine

Question 21

Lead OD Mx

Answer 21

Dimercaprol

Question 22

Cyanide OD Mx

Answer 22

hydroxocobalamin

Question 23

Lithium in pregnancy leads to what abnormality

Answer 23

Ebsteins anomaly (cardiac defect)

Question 24

Rifampicin
MOA
SE

Answer 24

MOA prevent transcription of DNA into mRNA
potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms

Question 25

Isoniazid MOA SE

Answer 25

MOA - inhibits mycolic acid synthesis SE - peripheral neuropathy: prevent with pyridoxine (Vitamin B6) hepatitis, agranulocytosis liver enzyme inhibitor

Question 26

Pyrazinamide MOA SE

Answer 26

MOA: converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I hyperuricaemia causing gout arthralgia, myalgia hepatitis

Question 27

Ethambutol MOA SE

Answer 27

MOA - inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan SE - optic neuritis: check visual acuity before and during treatment dose needs adjusting in patients with renal impairment

Question 28

P450 inducers

Answer 28

antiepileptics: phenytoin, carbamazepine barbiturates: phenobarbitone rifampicin St John's Wort chronic alcohol intake griseofulvin smoking (affects CYP1A2, reason why smokers require more aminophylline)

Question 29

P450 Inhibitors

Answer 29

antibiotics: ciprofloxacin, erythromycin isoniazid cimetidine,omeprazole amiodarone allopurinol imidazoles: ketoconazole, fluconazole SSRIs: fluoxetine, sertraline ritonavir sodium valproate acute alcohol intake quinupristin

Question 30

Digoxin toxicity precipitatnts

Answer 30

hypokalaemia CCB - verapamil, diltiazem amiodarone, spirinolactone AKI

Question 31

Azathioprine + Allopurinol lead to...

Answer 31

azathioprine toxicity = pancytopenia

Question 32

liver transplant for paracetamol overdose criteria

Answer 32

Arterial pH < 7.3, 24 hours after ingestion or all of the following: prothrombin time > 100 seconds creatinine > 300 µmol/l grade III or IV encephalopathy

Question 33

cocaine toxicity

Answer 33

benzodiazepine + GTN (if chest pain) + nitroprusside (if HTN)

Question 34

Tamoxifen SE

Answer 34

Hot flushes menstrual disturbance - PV bleed, amenorrhea endometrial Ca VTE

Question 35

Heart failure drug exacerbators

Answer 35

Flecainide NSAIDs/ glucocorticoids (apart from low dose aspirin) verapamil pioglitazone - causes fluid retention

Question 36

Aminoglycoside (gentamicin) SE (2)

Answer 36

ototoxicity nephrotoxicity

Question 37

Fluroquinolones (ciprofloxacin) SE

Answer 37

connective tissue damage eg achilles tendon rupture

Question 38

Macrolides (erythromycin, clarithromycin) SE

Answer 38

myopathy (muscle weakness), prolonged QT

Question 39

Tetracyclines (Doxycycline) SE

Answer 39

photosensitivity

Question 40

Finasteride MOA SE

Answer 40

MOA - 5 alpha reductase inhib SE - gynaecomastia, sexual dysfunction

Question 41

Lithium toxicity precipitated by drugs

Answer 41

dehydration AKI diuretics (esp thiazides), ACEi/ ARB, NSAIDS, Metronidazole

Question 42

HRT facts

Answer 42

progesterone essential to prevent endometrial ca (due to unopposed oestrogen) If hysterectomy - oestrogen-only is given cyclical HRT for perimenopause (<1yr LMP)

Question 43

Amitriptyline toxicity Fx Mx

Answer 43

prolonged QRS tachycardia, dry mouth, dilated pupils Mx - sodium bicarbonate

Question 44

Apirin (salicylate toxicity) Fx Mx

Answer 44

hyperventilation, tinnitus, sweating respiratory alkalosis followed by metabolic acidosis Mx - sodium bicarbonate, haemodialysis

Question 45

myasthenia gravis Mx

Answer 45

Pyridostigmine (acetylcholinesterase inhibitor)

Question 46

Arsenic toxicity antidote

Answer 46

dimercarpol

Question 47

Drug induced jaundice

Answer 47

nitrofurantoin erythromycin isonazid methyldopa

Question 48

Amiodarone SE

Answer 48

night glare taste disturbance (metallic)

Question 49

hypoKal

Answer 49

steroids loop diuretics

Question 50

ACEi SE

Answer 50

HyperKal hypotension

Question 51

Digoxin toxicity ECG

Answer 51

ST depression + T wave inversion (reverse tick)