Pharmacology

Question 1

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

Answer 1

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

Question 2

Metabolic abnormality caused by aspirin toxicity?

Answer 2

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.

Question 3

Which chemotherapeutic agents are most frequently associated with CV complications?

Answer 3

Athracyclines eg doxorubicin, daunorubicin, idarubicin and mitoxantrone

Question 4

What is the mechanism of Doxorubicin causing CV complications ?

Answer 4

Myocardial necrosis causing a dilated cardiomyopathy (reduced LVEF)

Question 5

Most significant SE of platinum based chemotherapeutic agents eg cisplatin?

Answer 5

Peripheral nerve damage

Question 6

SE of bleomycin

Answer 6

Interstitial pneumonitis

Question 7

What renal disease does lead poisoning cause

Answer 7

interstitial nephritis

Question 8

What are the neurotoxic SEs of vinicristine

Answer 8

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

Question 9

Which chemotherapeutic agents cause cardiomyopathy

Answer 9

Doxorubicin and danorubicin

Question 10

What is most common SE of methotrexate

Answer 10

hepatic and pulmonary fibrosis

Question 11

SE of cyclophosphamide

Answer 11

Haemorrhagic cystitis

Question 12

What ABX causes haemolytic anaemia in G6PD deficiency

Answer 12

Sulfonamides eg co-trimoxazole

Question 13

What antihypertensive increases tublar resorption of lithium

Answer 13

ACEI

Question 14

How is drug metabolism affected in the liver

Answer 14

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

Question 15

Which hepatic substrate transporter is rovustatin a substrate for

Answer 15

OATP1B1

Question 16

Name some substrates of CYP4502C9

Answer 16

NSAID, sulphonureas, ARB2 and warfarin

Question 17

What electrolyte abnormality does amphetamines cause

Answer 17

Hypokalaemia

Question 18

What metabolic abnormality is often associated with cisplatin treatment

Answer 18

Renal tubular acidosis

Question 19

Why is mild biochemical hyperthyroidism seen in pregnancy

Answer 19

bHCG stimulates production of thyroid hormone in similar manner to TSH

Question 20

What are the conventional indictations for dialysis in ethyle glycol ingestion

Answer 20

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

Question 21

What is main enyme pathway responsible for metabolism of pioglitazone

Answer 21

CYP2C8

Question 22

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

Answer 22

CYP2D6

Question 23

What level of lithium requires immediate haemodyalisis

Answer 23

> 4

Question 24

What chemotherapeutic agent causes peripheral neuropathy

Answer 24

cisplatin

Question 25

What are the features of theophylline toxiciy

Answer 25

N + V, seizures, tachycardia and hypokalaemia

Question 26

Which antibiotic is associated with acute tendon rupture

Answer 26

Quinolones

Question 27

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

Answer 27

ciclosporin

Question 28

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

Answer 28

Medulla oblongata

Question 29

Where do betahistine and prochlorperazine work?

Answer 29

vestibular nerve

Question 30

Drug treatment for partial epilepsy

Answer 30

Lamotrigine, note is safe for use with oestrogen OCP

Question 31

Treatment of cluster headaches

Answer 31

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

Question 32

Why does digoxin need to be loaded

Answer 32

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

Question 33

What is bosantan

Answer 33

Endothelin A and B receptor antagonist

Question 34

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

Answer 34

peripheral neuropathy

Question 35

Which TB drug causes visual disturbance

Answer 35

ethambutol

Question 36

What are the types of drug reaction?

Answer 36

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

Question 37

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

Answer 37

carbimazole

Question 38

What antiepileptic drug causes acne

Answer 38

phenytoin

Question 39

How is gold administered for RA

Answer 39

IM

Question 40

Main side effects d penicillamine

Answer 40

pancytopenia and acute interstitial nephritis

Question 41

How does activated charcoal work in poisoning

Answer 41

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

Question 42

When is thiopurine methyltransferase measured

Answer 42

when assessing risk of leukopenia when starting azathioprine

Question 43

Mode of action of ciclosporin

Answer 43

Il- 2 inhibitor (CYP3A4 also)

Question 44

What chemotherapeutic agent causes chemical cystitis?

Answer 44

Cyclophosphamide

Question 45

What are main SEs of chlorambutol

Answer 45

myelosuppression, hepatoxicity and azoospermia

Question 46

SEs of mephalan

Answer 46

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

Question 47

What cardiac drug causes GI and mucosal ulceration?

Answer 47

nicorandil (nifedipine causes gingival hypertrophy)

Question 48

What antibiotic can cause intracranial hypertension and how can it present

Answer 48

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

Question 49

What drugs does charcoal bind?

Answer 49

aspirin and paracetamol. does not bind lithium

Question 50

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

Answer 50

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

Question 51

Drugs that cause hyperprolactinaemia

Answer 51

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

Question 52

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

Answer 52

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

Question 53

What antibiotics increase INR in warfarin therapy

Answer 53

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

Question 54

mechanism of action of azathioprine

Answer 54

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

Question 55

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

Answer 55

macrolides, imidazole antifungals, diltiazem and verapamil

Question 56

Common causes of drug induced lupus

Answer 56

Procainamide, hydralazine, phenytoin, ethosiximide

Question 57

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

Answer 57

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

Question 58

mechanism of action of progesterone only OCP

Answer 58

thickens cervical mucous

Question 59

mechanism of action of theophylline

Answer 59

adenosine receptor antagonist. also blocks phosphodiesterase

Question 60

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

Answer 60

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

Question 61

What causes methaemoglobinaemia (Heinz bodies)

Answer 61

Nitrates

Question 62

Mechanism of action of dipyridamole

Answer 62

phosphodiesterase inhibitor

Question 63

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

Answer 63

increases it - enzyme inhibitiro

Question 64

what cancer are people with venous ulcers most at risk of

Answer 64

scc

Question 65

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

Answer 65

carbamezapine

Question 66

What antipsychotics can cause an oculogyric crisis

Answer 66

metocloperamide and prochlorperazine

Question 67

What is sitgliptin

Answer 67

DPP4 inhibitor - gliptin

Question 68

what is dapagliflozin

Answer 68

SGLT2 inhibitor - flozin

Question 69

what is liraglutide

Answer 69

GLP1 agonist - tide

Question 70

What can occur in lithium toxicity in nephrotic syndrome

Answer 70

Dyslipidaemia

Question 71

Site of k sparing diuretics

Answer 71

Distal distal convoluted tubule

Question 72

Moa adalimumab

Answer 72

Tnf alpha inhibitor

Question 73

Two main ketone produced by liver

Answer 73

Acetoacetatw and beta hydroxybuterate

Question 74

When is bisprolol contraindicated in pregnancy

Answer 74

First trimester

Question 75

What causes hypoglycaemia when drinking alcohol in t2dm

Answer 75

Increased first phase response

Question 76

What causes neuroleptic malignant syndrome

Answer 76

Dopamine antagonists

Question 77

Signs with NMS

Answer 77

RIGIDITY HYPOREFLEXIA

Question 78

Serotonin syndrome sx (x3)

Answer 78

Ocular clonus Myoclonus Hyperreflexia

Question 79

What electrolyte abnormality ca dioxin lead to

Answer 79

Malignant hyperkalaemia

Question 80

What drugs inhibit PDE-4

Answer 80

Copd drugs eg ronflumilast

Question 81

Which phase do most chemotherapeutic drugs act on

Answer 81

Metaphase

Question 82

Hla b1502

Answer 82

Risk of sjs when taking carbameezappine if Chinese han

Question 83

Have b27

Answer 83

Ank Spon Anterior uveitis IBD

Question 84

Hla dr2

Answer 84

Anti GBM SLE MS PBC

Question 85

Hla dr4

Answer 85

rheumatoid arthritis

Question 86

Can Beta blockers cause erectile dysfunction yes or no

Answer 86

Yes

Question 87

Is Ramipril CI in pregnancy

Answer 87

Yes

Question 88

who produces interferon gamma

Answer 88

Th1 differentiated T cells and NK cells

Question 89

What is I'll-4's function?

Answer 89

drives differentiation of naive t helper cells to Th2 cells

Question 91

what is benzobromarone

Answer 91

OAT-1 inhibitior - alternative when xanithine oxidase inhibitors ineffective

Question 92

what is febuxostat and what is a potential side effect

Answer 92

XOxidase inhibitor significant bone marrow depression

Question 93

what is MOA ticagrelor and clopidogrel

Answer 93

CYp12 inhibitor

Question 94

example of Glycoprotein IIb/IIIa inhibition

Answer 94

tirofiban