Pharmacology Flashcards
What medication can cause Dupuytren’s contracture?
phenytoin
What drugs cause gingival hyperplasia?
Phenytoin, ciclosporin, calcium channel blockers - especially nifedipine
What are common side effects of thiazide diuretics?
dehydration,
postural hypotension
hypontraemia, hypokaemia, hypercalcaemia,
gout
impaired glucose tolerance, impotence
What are the adverse effects of amiodarone?
Thyroid dysfunction: both hypo and hyperthyroidism
Corneal deposits
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Peripheral neuropathy
Photosensitivity
Bradycardia
Lengthens QT level
What are important drug interactions with amiodarone?
decreased metabolism of warfarin, therefore increased INR
increased digoxin levels
What is the moa of goserelin?
synthetic GnRH agonist - provides negative feedback to the anterior pituitary
What is Alport’s syndrome?
inherited x-linked dominant disorder - deficit in type IV collagen resulting in an abnormal GBM
What are the features of Alport’s syndrome?
microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus: protrusion of the lens surface into the anterior chamber
retinitis pigmentosa
renal biopsy
What vitamin deficiency causes bleeding gums?
Vitamin C
What vitamin deficiency causes diarrhoea, confusion and eczematous skin?
niacin
What vitamin deficiency causes osteomalacia?
vitamin D
what are the adverse effects of metoclopramide?
extrapyramidal side effects: acute dystonia e.g. oculogyric crisis
diarrhoea
hyperprolactinaemia
tardive dyskinesia
parkinsonism
what are the criteria for starting acetylcysteine in paracetamol OD?
- plasma conc is on or above a single treatment line of 100mg/L at 4 hrs
- staggered overdose (over >1 hour) or there is doubt over the time of paracetamol ingestion regardless of the plasma paracetamol concentration
- pts who present 8-24 hours after ingestion of an acute OD of more than 150mg/kg even if plasma conc is not yet available
- pts who present > 24 hrs if they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal
What is TEN?
Toxic epidermal necrolysis
Life threatening skin disorder commonly seen secondary to a drug reaction
Skin develops a scalded appearance over an extensive area
What are the features of TEN?
Systemically unwell e.g. pyrexia, tachycardia
Positive Nikolsky’s sign: the epidermis separates with mild lateral pressure
What drugs cause TEN?
Phenytoin
Sulphonamides
Allopurinol
Penicillins
Carbamazepine
NSAIDs
what should you do if you miss one COCP pill at any time in the cycle?
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day, no additional contraceptive protection needed
what should you do if you miss 2 or more of your COCP pills?
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one on each day
women should use condoms or abstain from sex until she has taken pills for 7 days in a row
if pills are missed in week 1 (day1-7): emergency contraception should be considered if she had unprotected sex in the pill free interval or in week 1
if pills are missed in week 2 (day 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception
if pills are missed in week 3 (day 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free period
what are the features of organosphosphate insecticide posioning?
DUMBELS:
D - defaecation and diaphoresis
U - urinary incontinence
M - Miosis (pupil constriction)
B - bradycardia
E - emesis
L - lacrimation
S - salivation
What are symptoms of aspirin toxicity?
acute symptoms: tinnitus, vertigo, nausea, vomiting, diarrhoea
Subsequent symptoms that suggest more severe intoxication: altered mental status, hyperpyrexia, non-cardiac pulmonary oedema, coma
what should you do if a patient on warfarin has INR 5-8 but no bleeding?
with-hold 1 or 2 doses of warfarin and reduce subsequent maintenance dose
what antibiotic most commonly causes cholestatic hepatitis?
co-amoxiclav
what sort of bacteria is strep pneumoniae?
gram positive
diplococci
blue/violet on gram stain
what sort of bacteria is strep pneumoniae?
gram positive
diplococci
blue/violet on gram stain
what is a phase 3 clinical trial?
comparing a new agent with an existing therapy
What are the signs of TCA overdose?
sedation, confusion, delirium, hallucinations
cardiac conduction delays, arrhythmias, hypotension and anticholinergic toxicity e.g. hyperthermia, flushing, dilated pupils are also common
what are bisphosphonates used for?
prevention and treatment of osteoporosis
hypercalcaemia
pagets disease
pain from bone mets
What should be done before giving bisphosphonates?
hypocalcaemia/vitamin D deficiency should be corrected before giving bisphosphonates
However when starting bisphosphonate treatment for osteoporosis, calcium should only be prescribed if dietary intake is inadequate
what combo of diuretics should never be given together?
amiloride and spironolactone - both potassium-sparing- can result in life-threatening hyperkalaemia
people who have aspirin hypersensitivity should not take which drugs?
mesalazine and sulfasalazine - salicylates
what are cautions and contraindications to ACE inhibitors?
- should be avoided in pregnancy and breast feeding
- renovascular disease - may result in renal impairment
- aortic stenosis - may result in hypotension
- specialist advice should be sought before starting ACE inhibitors in patients with a potassium > 5
what are the adverse effects of tamoxifen?
- menstrual disturbance: vaginal bleeding, amenorrhoea
- hot flushes
- VTE
- endometrial cancer
what monitoring needs to be done with phenytoin?
levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:
- adjustment of phenytoin dose
- suspected toxicity
- detection of non-adherence to the prescribed medication
What drugs should be avoided in breastfeeding?
antibiotics - ciprofloxacin, tetracyclines, sulphonamides, chloramphenicol
psychiatric drugs - lithium, benzodiazepenes
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
What is the MOA of pyridostigmine?
long acting anticholinesterase inhibitor
How should lithium be monitored?
- when checking lithium levels, the sample should be taken 12 hours post-dose
- after starting lithium, levels should be performed weekly and after each dose change until concentrations are stable
- once established, lithium blood level should normally be checked every 3 months
- after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable
- thyroid and renal function should be checked every 6 months
What medication should be given to palliative patients with terminal restlessness?
midazolam
what are the side effects of valproate?
teratogenic
nausea
increased appetite and weight gain
ataxia
tremor
hepatotoxicity
pancreatitis
thrombocytopenia
hyponatraemia
what is diclofenac contraindicated in?
ischaemic heart disease
peripheral arterial disease
cerebrovascular disease
congestive heart failure
what drugs can lower seizure threshold?
- ABX: imipenem, penicillin, cephalosporins, metronidazole, isoniazid, ciprofloxacin
- antipsychotics
- antidepressants: bupropion, tricyclics, venlafaxine
- tramadol
- fentanyl
- ketamine
- lidocaine
- lithium
- antihistamines
what pain medication can be used in people on haemodialysis?
tramadol
oxycodone
What is given for VTE prophylaxis in people with reduced creatinine clearance?
unfractionated heparin
What is given for VTE prophylaxis in people with reduced creatinine clearance?
unfractionated heparin
How long should a provoked PE - i.e where you know the cause - be treated for?
3 months
what are the effects of SSRI’s in pregnancy?
bnf says to weigh up benefits and risks when deciding whether to use in pregnancy
use during the first trimester gives a small increased risk of congenital heart defects
use during the third trimester can result in persistent pulmonary hypertension of the new-born
paroxetine has an increased risk of congenital malformations, particularly in the first trimester
what are absolute contraindications to use of COCP?
more than 35 y/o and smoking for than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies e.g. in SLE
what is the moa of latanoprost?
prostaglandin analogue
increases uveoscleral outflow
What are the kings college criteria for liver transplant in patients with paracetamol OD?
arterial pH < 7.3 24 hours after ingestion or all of the following:
- prothrombin time > 100s
- creatinine > 300
- grade III or IV encephalopathy
what are the side effects of bisphosphonates?
oesophageal reactions: oesophagitis, oesophageal ulcers
osteonecrosis of the jaw
increased risk of atypical stress fractures of proximal femoral shaft
hypocalcaemia
what are the side effects of bisphosphonates?
oesophageal reactions: oesophagitis, oesophageal ulcers
osteonecrosis of the jaw
increased risk of atypical stress fractures of proximal femoral shaft
hypocalcaemia
How should oral bisphosphonates be taken?
tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast; patient should stand or sit upright for at least 30 minutes after taking a tablet
what are the features of digoxin toxicity?
generally unwell, lethargy, nausea and vomiting, confusion, yellow-green vision
arrhythmias - AV block, bradycardia
gynaecomastia
what are the features of digoxin toxicity?
generally unwell, lethargy, nausea and vomiting, confusion, yellow-green vision
arrhythmias - AV block, bradycardia
gynaecomastia
how is digoxin toxicity treated?
digibind
correct arrhythmias
monitor potassium
what drugs can reduce the absorption of levothyroxine?
iron, calcium carbonate
what are the side effects of beta blockers?
bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction
how do you convert oral morphine to subcut morphine?
divide by 2
how do you convert oral morphine to subcut diamorphine?
divide by 3
how do you convert oral oxycodone to subcut diamorphine?
divide by 1.5
What is classed as an acceptable rise in creatinine following use of an ace inhibitor?
less than 30%
what type of DI does lithium cause?
nephrogenic
what should be co-prescribed with methotrexate?
folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose
what are the features of neuroleptic malignant syndrome?
occurs within hours to days of starting an antipsychotic and typical features are
- pyrexia
- muscle rigidity
- autonomic lability - hypertension, tachycardia, tachypnoea
- agitated delirium with confusion
a RAISED CREATININE KINASE IS PRESENT IN MOST CASES
what are extrapyramidal side effects?
parkinsonism
acute dystonia - sustained muscle contraction e.g. torticollis, oculogyric crisis - managed with procyclidine
- akasthisia - severe restlessness
- tardive dyskinesia - choreoathetoid movements e.g. chewing and pouting of jaw)
how is lithium toxicity managed?
mild-moderate = toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
what are the features of lithium toxicity?
coarse tremor - a fine tremor is seen in therapeutic levels
hyperreflexia
acute confusion
polyuria
seizure
coma
