Pharmacology💊 Flashcards by Maddie O'Connor-Manson

What can you offer as heroin substitutes?

Methadone or buprenorphine

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What is an important blood test to monitor in amiodarone use?

Thyroid function tests

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What are the symptoms of tricyclic overdose and what drugs can you use to manage this?

Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.

Features of severe poisoning include:
arrhythmias
seizures
metabolic acidosis
coma

ECG changes include:
sinus tachycardia
widening of QRS
prolongation of QT interval

Drugs management is IV sodium bicarbonate

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What is Tamoxifen?

Tamoxifen is a Selective oEstrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist.

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What is Lithium toxicity precipitated by?

dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

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What ECG changes do macrolides cause?

Prolongation of the QT interval

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Common side effect of doxycycline?

Photosensitivity

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What is the treatment of benzodiazepine overdose?

Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil

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What is the treatment of Lithium overdose?

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

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What is the treatment of Warfarin overdose?

Vitamin K, prothrombin complex

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When should you start acetylcysteine immediately in paracetamol overdose?

There is uncertainty about the time of overdose, but it is potentially toxic
The overdose was staggered over a time period longer than an hour
The plasma-paracetamol level is over the treatment line on the treatment graph
The overdose was taken 8-36 hours before presenting

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What is the ECG change seen in a tricyclic overdose?

QRS widening

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What drugs should you avoid in renal failure?

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

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When do you give activated charcoal?

If presenting within 1 hour of poisoning

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When do you start N-Acetylcysteine in paracetamol dose without levels?

If presentation 8-24 hours after ingestion of an overdose of more than 150 mg/kg start acetylcysteine even if the plasma-paracetamol concentration is not yet available
- Also if there is a staggered overdose

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What do you use to monitor unfractionated heparin?

APTT

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What are some common side effects of calcium channel blockers?

Headache, flushing, ankle oedema

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Give some examples of P450 inducers?

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

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Give some examples of P450 inhibitors?

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

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What is the monitoring for statins?

LFTs at baseline, 3 months and 12 months

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What is the monitoring for ACE inhibitors?

U&E prior to treatment
after increasing dose and at least annually

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What is the monitoring for Amiodarone?

TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months

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What is the monitoring for Azathioprine?

FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months

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What is the monitoring for Lithium?

TFT, U&E prior to treatment
Lithium levels weekly until stabilised then every 3 months
TFT, U&E every 6 months

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What is the monitoring for sodium valproate?

LFT, FBC before treatment LFT 'periodically' during first 6 months

What is the first line drug in the management of cocaine toxicity?

Benzodiazepines are first line

What is the dosage of breakthrough opioid analgesia?

1/6th of the total daily opioid dose

What are some drug causes of hypomagnesaemia?

Diuretics, and PPI

What is the effect of ACEi on a developing fetus?

Renal dysgenesis, craniofacial abnormalities

What is the effect of carbamazepine of a developing fetus?

Neural tube defects, craniofacial abnormalities

What is the effect of cocaine of a developing fetus?

Intrauterine growth retardation, preterm labour

Which antiemetic functions through inhibition of the neurokinin receptor?

Aprepitant

How does ondansetron work?

It is a 5HT3 antagonist

How does Domperidone work?

It is a antidopaminergic agent

What change can clarithromycin cause on ECG?

QT interval prolongation and therefore can trigger torsades de pointes

What drugs should not be used in G6PD deficiency and what can these trigger?

sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis

What diabetic medication has been linked to Fournier's gangrene?

SGLT-2 inhibitors

What is the antidote for Dabigatran?

Idarucizumab

What are side effects for topical corticosteroids?

- Acne - may occur due to sebaceous gland susceptible to inflammation and infection - Striae - impact on dermal connective tissue - Telangiectasia - Thinning of the skin - due to reduced collagen synthesis

What is the mechanism of action of Ergometrine?

It stimulates alpha-adrenergic, dopaminergic and serotonergic receptors

What can acamprosate be used for in problematic alcohol use?

It reduces cravings, known to be a weak antagonist of NMDA receptors

What are the common drug interactions of Allopurinol?

Azathioprine, cyclophosphamine, Theophylline

What are some side effects of Verapami?

Heart failure, constipation, hypotension, bradycardia, flushing

What should you be aware of with Verapamil and Beta blockers?

Do not use together as this may cause heart block

What type of drug is Digoxin?

Cardiac Glycoside used for rate control

What are the features of Digoxin toxicity?

- Generally unwell, lethargy, nausea and vomiting, anorexia, confusion - Yellow-Green vision - Arrhythmias (e.g. AV block, bradycardia) - Gynaecomastia

What drugs cause drug induced- thrombocytopaenia?

- Quinine - Abciximab - NSAIDs - Diuretics: furosemide - Antibiotics: Penicillins, Sulphonamides, rifampicin - Anticonvulsants: Carbamazepine, Sodium Valproate - Heparin

What drugs might cause urinary retention?

- tricyclic antidepressants - Anticholinergics e.g. antipsychotics, antihistamines - Opioids - NSAIDs - Disopyramide

What drugs might cause lung fibrosis?

- Amiodarone - Cytotoxic agents: busulphan, bleomycin - Anti-rheumatoid drugs: methotrexate, sulfasalazine - Nitrofurantoin - Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

What antibiotics are macrolides?

Erythromycin, Clarithromycin, Azithromycin

What is the mechanism of action of metformin?

Acts by activation of the AMP-activated protein kinase (AMPK) - Increased insulin sensitivity -Decrease hepatic gluconeogenesis

What are some adverse effects of Metformin?

Gastro upset is common Reduced B12 absorption (rarely a clinical problem) Lactic acidosis with severe liver disease or renal failure

When are PDE5 inhibitors contraindicated?

- patients taking nitrates and related drugs such as nicorandil. - Hypotension - Recent stroke or MI

What drugs should be avoided in renal failure?

Antibiotics (tetracycline and nitrofurantoin), NSAIDs, Lithium, Metformin

What are examples of quinolones?

Ciprofloxacin Levofloxacin

What are some common side effects of ACEi?

Cough, hyperkalaemia

What are some common side effects of Bendroflumethiazide?

Gout Hypokalaemia Hyponatraemia Impaired glucose tolerance

What are some common side effects of beta blockers?

Bronchospasms (especially in asthmatics) Fatigue Cold peripheries

What are common side effects of co-amoxiclav

Cholestasis

What are some common side effects of erythromycin?

Gastrointestinal upset, prolongs the QT interval

What are some side effects of ciprofloxacin?

Lowers seizure threshold Tendonitis

What are some common side effects of Sulfonylureas?

- Hypoglycaemic episodes - Increased appetite and weight gain - SiADH - Liver dysfunction (cholestatic)

What are some common side effects of Glitazones?

- Weight gain - Fluid retention - Liver dysfunction - Fractures

What are some common side effects of gliptins?

Pancreatitis

What type of drug is Tamoxifen?

A selective Oestrogen receptor modulator (SERM) Acts as an oestrogen receptor antagonist and partial agonists

What are some side effects of rifampicin?

Hepatitis, Orange/red coloured secretions Flu-like symptoms

What are some side effects of isoniazid?

Hepatitis, agranulocytosis

What are some side effects of pyrazinamide?

It causes arthralgia, myalgia and hepatitis

What factors can impair lithium clearance?

- Drugs: e.g. NSAIDs, ACEi, SSRIs, Thiazide diuretics, topiramate - Dehydration - Hyponatraemia - Hyperthyroidism - Renal impairment (acute or chronic)