Pharmacology Flashcards
Name some P450 inhibitors
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (binge)
Chloramphenicol
Erythromycin
Sulphonamides
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit juice
Name some P450 inducers
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
Name some side effects of amiodarone
Pulmonary fibrosis
Hepatotoxicity
Corneal deposits
Thyroid dysfunction
Blue-grey skin discolouration
Name some drugs which may worsen glycaemic control
Thiazide diuretics
Antipsychotics
Beta blockers
Corticosteroids
In which conditions should griseofulvin be avoided?
Pregnancy
Porphyria
Liver disease
How do you treat C. diff?
First line: vancomycin
Second line: Oral fidaxomicin for 10 days
Name some key statin side effects
Myositis
GI upset
Altered liver function
Rarely, pancreatitis and interstitial lung disease
Which antidepressants are considered safest in pregnancy?
Sertraline - can be used during breast feeding too
Fluoxetine
Name some SEs of ethambutol
Red-green colour blindness
Peripheral neuropathy
Optic neuritis
Name some suitable antihypertensives to use in pregnancy
Labetalol
Nifedipine
Methyldopa
Name some osmotic laxatives
Lactulose
Movicol
Phosphate
Sodium citrate
Name some bulk forming laxatives
Ispaghula husk
Methylcellulose
Which AED carries the highest risk of congenital malformations?
Sodium valproate
Metaclopromide is most suitable for which causes of N&V?
Gastritis
Gastric stasis
Functional bowel obstruction
Cyclizine is most suitable for which causes of N&V?
Mechanical bowel obstruction
Raised ICP
Motion sickness
Haloperidol is most suitable for which causes of N&V?
Metabolic - i.e. hypercalcaemia and renal failure
What topical agent can be used for fungal nail infection?
5% amorolfine nail laquer
Which drugs can increase saliva production?
Clozapine
Neostigmine
Name some SEs of viagra
Visual disturbances
Headaches
Nasal congestion
Flushing
GI upset
Define tardive dyskinesia
Repetitive, purposeless, involuntary movements
How long should antibiotics be prescribed for in men?
7 days
Which antidiabetic drug is associated with bladder cancer?
Pioglitazone
Which antidiabetic drug is associated with B12 deficiency?
Metformin
Which drugs can induce hyperuricaemia?
Alcohol
Diuretics - loop and thiazide
Salicylates
Pyrazinamide
Ethambutol
Nicotinic acid
Cytotoxic agents
Which drugs can cause lichenoid eruptions?
ACE-i
NSAIDs
Methyldopa
Chloroquine
Oral antidiabetics
Thiazide diuretics
Gold
What is the treatment for head lice?
Dimeticone 4% lotion
Wet combing
Which drug may be used in anorexia associated with cancer?
Prednisolone or dexamethasone
Which laxative may be helpful in the treatment of constipation in terminally ill patients?
Co-danthramer (combination laxative)
How does co-cyprindiol work?
A combination of:
Cytoproterone acetate (synthetic progestogen) - androgen receptor blocker
Ethinylestradiol
What is tibolone?
Oestrogen receptor agonist
Which drug limits the maximum dose of simvastatin to 20mg?
Amlodipine - weak inhibitor of CYP450
Name some SEs of SSRIs
Increased risk of GI bleeding
Increased anxiety and agitation
Describe the MOA of tramadol
A synthetic, centrally acting, opiate like analgesic
Seizures are a rare effect of tramadol
Which drug is useful for the treatment of nausea and vomiting in mechanical bowel obstruction?
Cyclizine
Name some important drug interactions to be aware of when prescribing azathioprine
Allopurinol: reduce dose
Febuxostat: not recommended
Co-trimoxazole/trimethoprim: increased risk of haem toxicity
Warfarin: anticoagulant effect reduced
Clozapine: increased risk of agranulocytosis
ACE-i: may cause anaemia
Aminosalicylates: bone marrow toxicity
Methotrexate: may require adjustment
What types of nausea and vomiting can be treated with metoclopramide?
Gastritis
Gastric stasis
Functional bowel obstruction
Name an important complication of metformin use
B12 deficiency
At what dose does aspirin toxicity occur?
> 250mg/kg
Name some side effects of adenosine
Flushing, chest pain and bronchospasm
Which drugs are useful in the treatment of primary open angle glaucoma?
Beta blockers
Sympathomimetics
Carbonic anhydrase inhibitors
These will reduce the production of aqueous humour
Prostaglandin analogues, sympathomimetics and miotics will increase the drainage of aqueous humour
Name some ECG changes seen in digoxin toxicity
ST changes
Inverted T waves in V4-6
Name some drugs that can cause urinary retention
Tricyclic antidepressants e.g. amitriptyline
Anticholinergics e.g. antipsychotics, Antihistamines
Opioids
NSAIDs
Disopyramide
Name some adverse effects associated with tamoxifen
Menstrual disturbance: vaginal bleeding, Amenorrhoea
Hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
Venous thromboembolism
Endometrial cancer
What monitoring is required for statins?
LFTs at baseline, 3 months and 12 months
What monitoring is required for amiodarone?
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
What monitoring is required for methotrexate?
FBC, LFT, U&E
What is the MOA of cocaine?
Cocaine blocks the uptake of dopamine, noradrenaline and serotonin
What is used for the management of chest pain associated with cocaine?
Benzodiazepines + glyceryl trinitrate
PCI if MI
Name some SEs of trimethoprim
Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis
What is the MOA of pyrazinamide?
Converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I
What are some SEs of pyrazinamide?
Hyperuricaemia causing gout
Arthralgia, myalgia
Hepatitis
Name some SEs of sildeanfil
Visual disturbances
blue discolouration
non-arteritic anterior ischaemic neuropathy
Nasal congestion
Flushing
Gastrointestinal side-effects
Headache
Priapism
What drugs are contraindicated in pregnancy?
ACE inhibitors, angiotensin II receptor antagonists
Statins
Warfarin
Sulfonylureas
Retinoids (including topical)
Cytotoxic agents
How do you treat ethylene glycol toxicity?
Ethanol has been used for many years
Works by competing with ethylene glycol for the enzyme alcohol dehydrogenase
this limits the formation of toxic metabolites (e.g. Glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning
Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
Haemodialysis also has a role in refractory cases
Name some precipitating factors for digoxin toxicity
classically: hypokalaemia
digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
increasing age
renal failure
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
What is the MOA of quinolones?
Inhibit topoisomerase II (DNA gyrase) and topoisomerase IV
Name some adverse effects of quinolones
Lower seizure threshold in patients with epilepsy
tendon damage (including rupture) - the risk is increased in patients also taking steroids
cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children
lengthens QT interval
Describe the management of lithium toxicity
mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion
Name some causes of drug induced thrombocytopaenia
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
Explain the MOA of metformin
acts by activation of the AMP-activated protein kinase (AMPK)
increases insulin sensitivity
decreases hepatic gluconeogenesis
may also reduce gastrointestinal absorption of carbohydrates
Name some drugs to avoid in renal failure
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
