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MRCP > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What drugs cause increased risk of toxicity by interaction with metformin? What is the likely biochemical abnormality?

A

Aminoglycosides, alcohol, cyclosporin and contrast media. Metabolic acidosis.

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2
Q

Metabolic abnormality caused by aspirin toxicity?

A

Initially respiratory alkalosis due to direct stimulation of respiratory centre and hyperventilation. Subsequently metabolic acidosis due to uncoupling of oxydative phosphorylation and build up of lactic acid and fatty acid metabolites.

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3
Q

Which chemotherapeutic agents are most frequently associated with CV complications?

A

Athracyclines eg doxorubicin, daunorubicin, idarubicin and mitoxantrone

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4
Q

What is the mechanism of Doxorubicin causing CV complications ?

A

Myocardial necrosis causing a dilated cardiomyopathy (reduced LVEF)

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5
Q

Most significant SE of platinum based chemotherapeutic agents eg cisplatin?

A

Peripheral nerve damage

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6
Q

SE of bleomycin

A

Interstitial pneumonitis

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7
Q

What renal disease does lead poisoning cause

A

interstitial nephritis

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8
Q

What are the neurotoxic SEs of vinicristine

A

peripheral neuropathy, paraesthesias, foot drop and wrist drop. Also SIADH

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9
Q

Which chemotherapeutic agents cause cardiomyopathy

A

Doxorubicin and danorubicin

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10
Q

What is most common SE of methotrexate

A

hepatic and pulmonary fibrosis

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11
Q

SE of cyclophosphamide

A

Haemorrhagic cystitis

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12
Q

What ABX causes haemolytic anaemia in G6PD deficiency

A

Sulfonamides eg co-trimoxazole

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13
Q

What antihypertensive increases tublar resorption of lithium

A

ACEI

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14
Q

How is drug metabolism affected in the liver

A

Drug processing via mixed function oxidases are affected in early liver disease whereas conjugation reactions are affected to a lesser extent and problems only arise in much later disease

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15
Q

Which hepatic substrate transporter is rovustatin a substrate for

A

OATP1B1

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16
Q

Name some substrates of CYP4502C9

A

NSAID, sulphonureas, ARB2 and warfarin

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17
Q

What electrolyte abnormality does amphetamines cause

A

Hypokalaemia

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18
Q

What metabolic abnormality is often associated with cisplatin treatment

A

Renal tubular acidosis

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19
Q

Why is mild biochemical hyperthyroidism seen in pregnancy

A

bHCG stimulates production of thyroid hormone in similar manner to TSH

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20
Q

What are the conventional indictations for dialysis in ethyle glycol ingestion

A

Acidosis <7.25pH, acute kidney disease or ethylene glycol level >500

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21
Q

What is main enyme pathway responsible for metabolism of pioglitazone

A

CYP2C8

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22
Q

Which enzyme pathway is responsible for metabolism of antipsychotics and also converts codeine to morphine

A

CYP2D6

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23
Q

What level of lithium requires immediate haemodyalisis

A

> 4

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24
Q

What chemotherapeutic agent causes peripheral neuropathy

A

cisplatin

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25
Q

What are the features of theophylline toxiciy

A

N + V, seizures, tachycardia and hypokalaemia

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26
Q

Which antibiotic is associated with acute tendon rupture

A

Quinolones

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27
Q

What is hypertrichosis, gum hyperplasia and hyperuricaemia associated with (chemotherapeutic drug)

A

ciclosporin

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28
Q

WHere do drugs like granisetron (5HT3 receptor antagonists) work?

A

Medulla oblongata

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29
Q

Where do betahistine and prochlorperazine work?

A

vestibular nerve

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30
Q

Drug treatment for partial epilepsy

A

Lamotrigine, note is safe for use with oestrogen OCP

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31
Q

Treatment of cluster headaches

A

Sumatriptan if acute attack, lithium or verapamil if 3 or more attacks

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32
Q

Why does digoxin need to be loaded

A

Very large volume of distribution meaning it is rapidly distributed to body parts and resulting in low blood levels

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33
Q

What is bosantan

A

Endothelin A and B receptor antagonist

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34
Q

What are rapid acetylators of isoniazid more likely to be exposed to ?

A

peripheral neuropathy

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35
Q

Which TB drug causes visual disturbance

A

ethambutol

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36
Q

What are the types of drug reaction?

A

A - dose related, likely predictable
B - unpredictable
C - in setting of prolonged drug use
D - late after treatment
E - related to withdrawal

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37
Q

What antithyroid drug causes alopecia, N + V, agranulocytosis, pruritus and arthralgia

A

carbimazole

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38
Q

What antiepileptic drug causes acne

A

phenytoin

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39
Q

How is gold administered for RA

A

IM

40
Q

Main side effects d penicillamine

A

pancytopenia and acute interstitial nephritis

41
Q

How does activated charcoal work in poisoning

A

aids elimination of drugs that are prone to enterohepatic circulation - absorbs drugs excreted in bile and prevents reabsorption in small bowel

42
Q

When is thiopurine methyltransferase measured

A

when assessing risk of leukopenia when starting azathioprine

43
Q

Mode of action of ciclosporin

A

Il- 2 inhibitor (CYP3A4 also)

44
Q

What chemotherapeutic agent causes chemical cystitis?

A

Cyclophosphamide

45
Q

What are main SEs of chlorambutol

A

myelosuppression, hepatoxicity and azoospermia

46
Q

SEs of mephalan

A

BM suppression, amenorrhoea, sterility, pulmonary infiltrates and inappropriate secretion of ADH

47
Q

What cardiac drug causes GI and mucosal ulceration?

A

nicorandil (nifedipine causes gingival hypertrophy)

48
Q

What antibiotic can cause intracranial hypertension and how can it present

A

Tetracycline, amiodarone, OCP - presents with VIth nerve palsy(headache, blurred vision, convergent squint and unable to adduct L eye beyond midline)

49
Q

What drugs does charcoal bind?

A

aspirin and paracetamol. does not bind lithium

50
Q

What conditions can exacerbate isoniazid’s role in causing peripheral neuropathy

A

High doses, slow acelator status and other conditions such as AIDS, alcoholism, diabetes and malnutrition

51
Q

Drugs that cause hyperprolactinaemia

A

Amitryptaline, chlorpromazine, haloperidol, risperidone, metocloperamide, methyldopa, TCAs, MAOIs, isoniazid

52
Q

Name these antimalarials in order of schizonticide fast to slow ( artemisinin, pyrimethamine, mefloquine, mecaprine and quinine

A

artemisinin (fast), mecaprine (f), quinine, (intermediate) mefloquine (intermediate), doxycycline is slow, pyrimethamine is slow

53
Q

What antibiotics increase INR in warfarin therapy

A

macrolides and quinolones. also metronidazole, cimetidine and allopurinol . Enzyme inhibitors

54
Q

mechanism of action of azathioprine

A

purine synthetase inhibitor. essential step in purification of lymphocytes and leukocytes

55
Q

What medications are inhibitors of CYP3A4 that need to be treated with caution when using ciclosporin (increase levels)

A

macrolides, imidazole antifungals, diltiazem and verapamil

56
Q

Common causes of drug induced lupus

A

Procainamide, hydralazine, phenytoin, ethosiximide

57
Q

What do beta lactams (pencillins, cephalosporins and monobactams eg aztreonam) and peptidoglycans (vanc and teicloplanin) have in common

A

both inhibit cell wall synthesis therefore ineffective against bacteria that have no peptidoglycan cell wall eg chlamydia

58
Q

mechanism of action of progesterone only OCP

A

thickens cervical mucous

59
Q

mechanism of action of theophylline

A

adenosine receptor antagonist. also blocks phosphodiesterase

60
Q

Causes of drug induced haemolysis (in context on G6PD deficiency)

A

dapsone, primaquine, aspirin or quinolones. AI acquired haemolysis recognised complication of penicillins, quinine, quinidine or methyldopa

61
Q

What causes methaemoglobinaemia (Heinz bodies)

A

Nitrates

62
Q

Mechanism of action of dipyridamole

A

phosphodiesterase inhibitor

63
Q

What effect does ethambutol have on INR if used with warfarin therapy

A

increases it - enzyme inhibitiro

64
Q

what cancer are people with venous ulcers most at risk of

A

scc

65
Q

what drug is associated with HLA b 1502 causing SJ syndrome in a chinese population

A

carbamezapine

66
Q

What antipsychotics can cause an oculogyric crisis

A

metocloperamide and prochlorperazine

67
Q

What is sitgliptin

A

DPP4 inhibitor - gliptin

68
Q

what is dapagliflozin

A

SGLT2 inhibitor - flozin

69
Q

what is liraglutide

A

GLP1 agonist - tide

70
Q

What can occur in lithium toxicity in nephrotic syndrome

A

Dyslipidaemia

71
Q

Site of k sparing diuretics

A

Distal distal convoluted tubule

72
Q

Moa adalimumab

A

Tnf alpha inhibitor

73
Q

Two main ketone produced by liver

A

Acetoacetatw and beta hydroxybuterate

74
Q

When is bisprolol contraindicated in pregnancy

A

First trimester

75
Q

What causes hypoglycaemia when drinking alcohol in t2dm

A

Increased first phase response

76
Q

What causes neuroleptic malignant syndrome

A

Dopamine antagonists

77
Q

Signs with NMS

A

RIGIDITY
HYPOREFLEXIA

78
Q

Serotonin syndrome sx (x3)

A

Ocular clonus
Myoclonus
Hyperreflexia

79
Q

What electrolyte abnormality ca dioxin lead to

A

Malignant hyperkalaemia

80
Q

What drugs inhibit PDE-4

A

Copd drugs eg ronflumilast

81
Q

Which phase do most chemotherapeutic drugs act on

A

Metaphase

82
Q

Hla b1502

A

Risk of sjs when taking carbameezappine if Chinese han

83
Q

Have b27

A

Ank Spon
Anterior uveitis
IBD

84
Q

Hla dr2

A

Anti GBM
SLE
MS
PBC

85
Q

Hla dr4

A

rheumatoid arthritis

86
Q

Can Beta blockers cause erectile dysfunction yes or no

A

Yes

87
Q

Is Ramipril CI in pregnancy

A

Yes

88
Q

who produces interferon gamma

A

Th1 differentiated T cells and NK cells

89
Q

What is I’ll-4’s function?

A

drives differentiation of naive t helper cells to Th2 cells

90
Q
A
91
Q

what is benzobromarone

A

OAT-1 inhibitior - alternative when xanithine oxidase inhibitors ineffective

92
Q

what is febuxostat and what is a potential side effect

A

XOxidase inhibitor
significant bone marrow depression

93
Q

what is MOA ticagrelor and clopidogrel

A

CYp12 inhibitor

94
Q

example of Glycoprotein IIb/IIIa inhibition

A

tirofiban

95
Q
A

MRCP (14 decks)

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