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RACP 2023 > PHARMACOLOGY > Flashcards

PHARMACOLOGY Flashcards

1
Q

Antidotes?

Benzos
Anticholinergics
TCA
Ethylene glycol
Aspirin
Digoxin
Dabigatran
Oragnophosphate
Fe
Lead
CCB
BB
Methemoglobinemia
MTX

A

Flumanezil
Physostigmine
Na bicarb
Ethanol
Bicarb, dialysis
Digibind
Idracizumab
Atropine
Desferrozamine
DMSA
Ca, atropine
Insulin dex, adrenaline
Methylene blue
Na bicarb

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2
Q

Can’t use activated charcoal for poisonings in?

A

Acids, alkali, metals, alcohols

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3
Q

Digoxin poisoning: clinical and ECG findings?

A

Digoxin causes cardiovascular toxicity and hyperkalaemia, but onset is delayed by hours while the drug is being distributed into the myocardium and other tissues.

ECG: slow AF/ AV block/ bradyarrhythmia, VT/VF, PAT, reverse tick ST depression, hyperkalemia

Clin: GI/CNS SE’s

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4
Q

Digoxin poisoning treatment?

A

Fluids
Electrolyte
WH other cardiac meds: BB/CCB, hyperkalemic agents, anything that could worsen it
Digibind if unstable/ hyperkalemic/ arrest/ end organ dysfunction

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5
Q

Antidepressant poisoning for all classes? Manifestations and management.

A

Mirtazipine: CV/CNS - relatively safe

MAOIB: ACh/ sympathomimetic - can be lethal

SSRI: sympathomimetic/ACh/CV

SNRI: sympathomimetic/ACh/CV

TCA: significant lethality; ACh + CV

Tx:
- TCA: bicarb if acidosis
- activated charchoal
- benzos for seizures
- cardiac monitoring
- fluids

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6
Q

OHA’s/ insulin poisoning management?

  • Insulin
  • Metformin
  • Sulfonylureas
A

Insulin: replace electrolytes, IV glucose

Metformin: dialysis if pH < 7.0/ lactate > 20, Na bicarb, charchol

Sulphonylureas: Glucose, octreotide, activated charcoal

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7
Q

Antipsychotic overdose symptoms and management?

A

Symptoms
- CV: tachy, hypotension, QTc prolongation
- CNS: depression, seizures
- Anticholinergic SE’s

Treatment
- Activated charcoal
- GI decontamination
- Norad if hypotensive
- IVF

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8
Q

How is paracetamol normally metabolised? What changes with toxicity?

A

Normal
- glucorinidated 95%
- CYP450 and Glutathione detoxified 5%

Toxicity
- Glurodinate sufulated saturated –> goes down CYP450 pathway
- Glutathione used up –> produces NAPQI which is toxic

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9
Q

What increases risk of hepatotoxicity in paracetamol overdose?

A

HIV
Malnourished
Liver enzyme inducer

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10
Q

How to decide when to stop NAC?

A

ALT decreasing
INR normalised
paracetamol conc low
clinically well

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11
Q

Examples of low and high clearance drugs (from liver)?

A

Low clearance
- Benzos
- Anticonvulsants
- NSAIDs

High clearance
- Antipsychotics
- Antidepressants
- Narcotics
- BB
- CCB

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12
Q

High clearance drugs depend on __
Low clearance drugs depend on __

A

High –> blood flow
Low –> enzyme

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13
Q

What is the difference between potency and efficacy?

A

Efficacy: maximum effect
Potency: concentration at which 50% effect achieved

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14
Q

What happens if you give full agonist and partial agonist together? (methadone and buprenorphine)

A

Partial agonist starts being an ANTAGONIST –> full effect goes down

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15
Q

What happens if you give agonist and competitive antagonist?

A

Efficacy same, potency decr

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16
Q

What happens in tachyplaxis? Examples? Draw graph.

A

Receptors getting used to drug

Cocaine, BB, nitrates

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17
Q

What happens in anticlockwise hysteresis?

A

Desitrbuting to site of action; drug has incr effect over time

Dig, warfarin,

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18
Q

Abx killing types? State the drug
1) Time above MIC
2) Peak conc, MIC
3) AUC/MIC

A

1) Beta lactams
2) Aminoglycosides
3) Vanc

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19
Q

Formula for Vd?

A

Amount of drug in body/ amount of drug in plasma

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20
Q

How does food increase/decrease bioavailability

A

Fast absorption of food: more in body
Slow absorption of food: less in body

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21
Q

Formula for loading dose?

A

LD = Vd x Plasmaconc

22
Q

Does giving a larger loading dose mean you will get to steady state quicker?

A

Only if
- dosing interval same as half life
- loading dose is double
Then immediately achieves steady state

If not 4-5 half lives

23
Q

Maintenance dose formula?

24
Q

Most drugs are zero order or first order kinetics?

A

First order

25
Hepatic Cl formula?
Hep Cl = ER x BF
26
Which drugs need to be reduced in liver impairment? High or low clearance? Examples?
Low clearance - benzos - anti epileptics - NSAIDs
27
Clearance determines?
Dose rate
28
Clearance formula?
IV - Cl = dose / AUC PO - Cl = dose x F / AUC
29
Half life determines the?
dosing rate/interval
30
Dose rate formula?
Plasma steady state x clearance
31
What can you use urinary alkalisation for?
MTX Aspirin
32
What can you use hemodilaysis for?
metformin lithium salicylates toxic alcohols
33
What can prognosticate digoxin poisoning?
Degree of hyperK reflects degree of toxicity + predicts risk of death (not cause of death)
34
Indications to start NAC?
○ Above line at 4 hours ○ Signs of hepatotoxicity: liver tenderness, GI symptoms, elevated ALT/AST on presentation ○ Liver failure even without a paracetamol history ○ Suspected ingestion > 7.5g and PCT concentration unavailable ○ Unknown time of ingestion and § Concentration PCT > 10 Evidence of liver injury
35
When to stop NAC?
Limit duration to 3 days - If ALT elevated/ serum con detectable can continue - Stop when conc undetectable/ ALT decreasing normal, INR < 2.0
36
Opioid receptor types:
Mu Kappa Delta
37
Opioid effect on hormones?
Large doses --> inhibit GABA and cause a burst of DA neuron activity Inhibits pituitary hormone release Reduces thyrotropin Increased GH Resp depression Reduces gut motility Methdone can prolong QT interval
38
Opioids withdrawal treatment?
Buprenorphine DIazepam
39
Options for opioid dependence?
Methadone Buprenorphine Naltrexone
40
Smoking cessation options
NRT Vernicicline: Nicotine partial agonist (SE: CVD) Antidepressants: notriptyilline, buproprion
41
How is alcohol broken down in liver?
Ethanol --> alcohol dehydrogenase --> Acetyldehyde Acetyldehyde --> Acetyl dehydrogenase --> acetate Acetate --> CO2 water When too much bring produced --> acetyl coA --> FA's Too much alcohol --> CYP2E1 overwhelmed --> produced ROS
42
Acute and chronic complications of alcohol excess?
ACUTE - Wernicke's: confusion, ataxia, ophthalmoplegia - hypoglycemia - NMDA surpassed, increased GABA - DA release - disturbed sleep CHRONIC - neuropathy - cerebellar degeneration - korsakoff's: retro/anterograde amnesia, confabulation - absorption: esp thiamine - cognition + brain atrophy
43
Alcohol withdrawal timing?
early: 6 hrs - 2 days late: delirium terms up to 4 days
44
Which substances cause withdrawal seizures?
ONLY BENZOS AND ALCOHOL CAUSES WITHDRAWAL SEIZURES
45
Giving thiamine in alcohol withdrawal helps with what?
ocular palsies: most quickly confusion/ataxia more slowly: may be residual defects
46
Options for alcohol dependence?
Naltrexone: □ Blocks opioid receptors --> decreases DA Acamprosate: □ inhibits NMDA receptor --> decreases symptoms of withdrawal Disulfiram: □ Raises acetyldehyde concentration --> aldehyde reaction Topiramate/ gabapentin/ ondansetron/
47
CO poisoning: what increases risk of long term complications?
- Cardio/cerebrovascular disease - Sustained LOC - Neuro abnormalities after waking from coma - Exposure > 15 hours
48
Complications of CO poisoning?
- Delayed neuropsych syndrome ○ Cognitive deficit ○ Personality changes ○ Movement disorders ○ Focal deficit Can last 240 days post exposure
49
CO poisoning treatment?
- HFNP for atleast 6 hours initially - IVF if hypotensive - Ionotropic/circulatory support if concerns of myocardial depression ○ ECG monitoring
50
Salicylate poisoning causes?
- Aspirin - Wintergreen oil (essential oil) --> methyl salicylate - Choline salicylate (analgesic gel, including for teething) Salicylic acid: teething gels, skin peeling gels
51
Salicylic acid treatment?
- Decontamination with activated charcoal - Urinary alkalinisation
52
What can't you use activated charcoal for?
Cannot be used for acids, alkali, alcohols, ions/metals E.G. LITHIUM

RACP 2023 (17 decks)

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