Pharmacology Flashcards
How does acute intermittent porphyria often present? (2)
Age
Abdominal and neuropsychiatric symptoms
20-40yo
What medication promotes ETOH abstinence?
Contraindications (2)
Disulfram
Ischaemic heart disease, psychosis
What is acamprosate used in? MOA
NMDA antagonist
Used to reduce cravings for ETOH
Allopurinol SE
Dermatological e.g Steven Johnson’s, severe cutaneous adverse reaction etc
Amiodarone SE (8)
Thyroid dysfunction
Corneal deposits
Pulmonary fibrosis
Liver fibrosis
Peripheral neuropathy
Slate grey appearance
Bradycardia
Long QT
Amiodarone effect on warfarin and digoxin
Increases INR and digoxin levels
P450 inhibitors
SICKFACES.COM
Increases levels/ toxicity/ reduces excretion
Sodium valproate/ SSRI
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol..binge drinking acute, allopurinol, amiodarone
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit juice
P450 inducers
CRAP GPS
Increased breakdown, lowers levels in the blood, increases excretion
Carbemazepines, chronic
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas , St John’s wart, smoking
Contraindications to sildenafil (3)
Patients taking nitrates e.g nicorandil
Hypotension
Recent stroke/ MI (wait six months)
Sildenafil SE (6)
Visual disturbances (blue discolouration)
Nasal congestion
Flushing
GI effects
Headache
Priapism
Where does spiro work?
Acts in the cortical collecting ducts
What is amiloride?
Where does it work?
K+ sparing diuretics
Distal convoluted tubule
Name four medications which can exacerbate heart failure
Pioglitazone (SE fluid retention)
Verapamil
NSAIDS/ steroids
Flecainide
Name four drugs to avoid in renal failure
NSAIDs
Lithium
Metformin
Tetracycline/ nitro
Drugs safe in CKD (4)
Abx (2)
Blood thinner (1)
Benzo
Erythromycin
Rifampacin
Diazepam
Warfarin
Name three anti-epileptics that harmful in pregnancy
Sodium valproate
Carbamezapine
Phenytoin
Medications not safe in pregnancy (6)
Warfarin
Statin
Sulfonylureas
Retinoids
ACE inhib
Tetracyclines
Adverse effects quinolones (3)
Tendon damage
Lengthen QT
Lower seizure threshold
Feature of serotonin syndrome (5)
Hyperreflexia
Myoclonus
Rigidity
Hyperthermia
Sweating
SE CCB (3)
Headache
Flushing
Ankle oedema
SE bendroflumethiazide (3)
Gout
Low potassium and sodium
Impaired glucose tolerance
BB SE (3)
Cool peripheries
Impaired glucose tolerance
Bronchospasm
Common SE
Amoxi (1)
Coamox (1)
Fluclo (1)
Rash
Cholestasis
Cholestasis
Common SE
Erythro (2)
Cipro (2)
Metro (1)
GI upset, long QT
Seizure lower threshold, tenodinitis
Reaction with ETOH
Common SE
Doxy (1)
Trimethoprim (2)
Photosensitivity
Rashes, pruritis
SE metformin (2)
GI
Lactic acidosis
Sulfonylureas SE (4)
Hypoglycaemia
Weight gain
SIADH
Liver dysfunction
Glitazones SE (4)
Weight gain
Fluid retention
Liver dysfunction
Fractures
Gliptin SE
Pancreatitis
Lithium range
When to take the level
0.4-1
12 hours post dose
Digoxin when to check the level?
At least 6 hours post dose
Phenytoin when to check the level?
Trough, immediately before next dose
SE TB drugs
Rifampacin (3)
Flu like symptoms
Hepatitis
Red urine
SE TB drugs
Isoniazid (3)
Peripheral neuropathy
Agranulocytosis
Hepatitis
Pyrazinamide (3)
SE TB drugs
Gout
Arthralgia
Hepatits
SE TB drugs
Ethambutol (1)
Optic neuritis
What is the Yellow Card Scheme for?
Report adverse reactions
SE verapamil (4)
Flushing
Heart failure
Constipation
Hypotension
Diltiazem SE (4)
Ankle swelling
Hypotension
Bradycardia
Heart failure
Features of CO poisoning (5)
Headache
N&V
Vertigo
Confusion
Pink skin and mucosae
CO poisoning
Ix (2)
Mx (2)
VBG/ABG
CarboxyHb levels
Mx
1. High flow oxygen through non re-breathe for a minimum of 6 hours
2. Hyperbaric oxygen
Ciclosporin
Adverse effects (4)
Gingival hyperplasia
Hypertrichosis
Impaired glucose tolerance
Hyperlipidemia
Indications for ciclosporin (4)
Post organ transplant
RA
Psoriasis
UC
Neurological effects of cocaine (4)
Seizures
Hypertonia
Hyperreflexia
Mydriasis
Mx cocaine toxicity
General (1)
CP (1)
HTN (1)
Benzos
CP GTN
HTN sodium nitroprusside
Diclofenac is contraindicated in (4)
Ischaemic heart disease
PAD
Cerebrovascular disease
Congestive heart failure
Digoxin toxicity
When to check the level?
8 to 12 hours post dose
Digoxin toxicity features (4)
Gynaecomastia
Arrhythmias
N&V, confusion
Yellow green vision
Precipitating factors for digoxin toxicity (6)
- Hypokalaemia
- Increasing age
- Renal failure
- MI
- Hypomagnesium
- High calcium and sodium
Mx digoxin toxicity (1)
Digibind
Drug monitoring
Statin
LFTs
Baseline, 3 + 12 months
Drug monitoring
ACE
U+E
Prior to rx, after increasing dose and annually
Drug monitoring
Amiodarone
TFT, LFT every 6 months
TFT,LFT, U+E, CXR prior to treatment
Drug monitoring
Glitazone
LFT
Before treatment and regularly
Drug monitoring
Lithium
Lithium level, TFT, U+E
TFT, U+E prior to treatment + every 6 months
Lithium weekly until stabilised
Drug monitoring
Sodium valproate
LFT FBC before treatment
LFT regularly during first 6 months
Drug monitoring
MTX
FBC, LFT, U+E
Before rx started and weekly until stabilised, then every 2-3 months
Drug monitoring
AZT
FBC LFT before treatment and every 3 months
FBC weekly for 4 weeks
Name five drugs that can cause impaired glucose tolernace
Steroids
Thiazides
Ciclosporin
Antipsychotics
BB
Drugs causing lung fibrosis (5)
Amiodarone
MTX
Sulfasalazine
Bromocriptine
Cabergoline
Features of ecstasy poisoning (3)
Hyponatraemia
Hyperthermia
HTN
Adverse effects finasteride (4)
Impotence
Decreased libido
Ejaculation disorder
Gynaecomastia
Heparin overdose can be reversed by?
Protamine sulphate
Premature menopause
How long should HRT be continued for?
Until 50yo
Name two drugs that can cause low mag
Name four other causes of low mag
Diuretics
PPIs
ETOH
Diarrhoea
Low K+
High calcium
paraesthesia
tetany
seizures
arrhythmias
decreased PTH secretion → hypocalcaemia
ECG features similar to those of hypokalaemia
exacerbates digoxin toxicity
=
Hypomagnesiumia
(similar to low calcium)
When to give IV mag replacement versus PO
<0.4 IV 40mmol over 24 hours
>0.4 PO 10-20mmol PO/day
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
=
Lithium toxicity
Mx lithium toxicity (2)
Fluids
Haemodialysis
Overdose and poisoning management
Paracetamol (2)
Salicyclate (2)
Opiods (1)
Activated charcoal if <1 hour
NAC
IV bicarb
Haemodialysis
Naloxone
Overdose and poisoning management
Benzos (1)
TCAs (2)
Lithium (2)
Flumezanil
IV bicarb
Dialysis
Fluids
Haemodialysis
Overdose and poisoning management
Heparin (1)
BB (1)
Methanol (2)
Protamine sulphate
Atropine
Fomepizaole
Haemodialysis
Overdose and poisoning management
Organophosphate insecticides (1)
Iron (1)
Atropine
Desferrioxamine
Overdose and poisoning management
Lead CO (2)
Cyanide (1)
Ethylene glycol (1)
100% oxygen
Hyperbaric oxygen
Hydroxocobalamin
Fomepizole
Salivation
Lacrimation
Urination
Defecation/diarrhoea
(SLUD)
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation
=
Organophosphate insecticide poisoning
Mx of opioid dependence (2)
How long should detox last? Inpt versus community
Methadone
Buprenorphine
4 weeks
12 weeks
Name two medications that can cause occulogyric crisis (2)
Mx (2)
Antipsychotics
Metoclopramide
Benztropine
Procyclidine
Motion sickness mx (3)
Transdermal hyoscine
Cyclizine
Cinnarizine
What creatinine should lead to a review in metformin, when should it be stopped
> 130
150
Iodine XRs such as coronary angio can increase risk of renal impairment. If on metformin when should it be discontinued and restarted
On the day of the procedure and 48 hours after
SE of mefloquine (3)
How long can it last?
Neuropsychiatric side effects
- suicide and deliberate self harm
- nightmares
- anxiety
Long half life so can continue for several months
Examples of macrolides (3)
Adverse effects (2)
Clarithro
Azithro
Erythro
Bacteriostatic
Long QT
Cholestatic jaundice
Azithro SE (2)
Hearing loss
Tinnitus