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Other MRCEM part 1 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

IV treatment for torsade de pointes

A

Magensium

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2
Q

What drug can be used in addition to adrenaline in patients with anaphylaxis and taking Beta-blockers?

A

Glucagon

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3
Q

What states predispose to digoxin toxicity?

A

Hypoxia, hypercalaemia, hypokalaemia, hypomagnesaemia

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4
Q

Contraindications for nitrous oxide

A

In patients with air containing closed spaces e.g. pneumothorax
Raised ICP

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5
Q

Mechanism for ACEi caused cough

A

Decreased bradykinin breakdown

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6
Q

Nitromidazole class MOA

A

Bacterial nucleic acid synthesis inhibitor

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7
Q

Quinolones MOA

A

Bacterial nucleic acid synthesis inhibitor

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8
Q

How long does a lidocaine adrenaline block last?

A

90 mins

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9
Q

Digoxin contraindications

A

VT
Hypertrophic cardiomyopathy
Intermittent complete heart block
WPW

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10
Q

What increases theophylliine serum concentration?

and decreases…?

A

HF
Hepatic impairment
Viral infections
Fever
Elderly

Smoking and alcohol

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11
Q

When should the BCG vaccine be given in infancy?

A

40/100,000 incidence in the area
Or parents / grandparents born in a high incidence country

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12
Q

Digoxin MO and actions

A

Cardiac glycoside
Increases the force of myocardial contraction and slows the HR

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13
Q

Flecanide MOA

A

Blocks Na 2+ fast channels on cardiac tissues (inhibit influx of extracellular Na2+, decreases rate of the actiona potential

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14
Q

Contraindication for colchicin

A

Blood disorders

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15
Q

Short term management of HTN due to pheochromocytoma

A

Alpha blocker

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16
Q

Max dose of atropine in bradyarrhthmias with adverse features

A

3mg

(500 mcg IV every 3-5 mins up to a max doses of 3mg)

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17
Q

Define barbituate?

A

any of a class of sedative and sleep-inducing drugs derived from barbituric acid.

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18
Q

Preferred drug for RSI

A

Thiopental

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19
Q

Cautions / contraindications

A

Barbituates can induce hepatic enzymes, producing porphyrins

Can induce acute prophyria

Therefore contraindicated with those know to have genetic defect leading to the above

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20
Q

Side effects of thiopental

A

Extravasation -> tissue damage
Involuntary muscle movements on induction
Cough and laryngospasm
Arrythmias
Hypotension
Headache

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21
Q

Etomidate is…

A

Anaesthetic agent used for induction

(NOT used for maintence(

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22
Q

Etomidate suppresses…

A

Adrenocorticol functin

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23
Q

Which induction agent causes the least CV depression

A

Etomidate

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24
Q

Why has etomidate become less popular

A

Single induction dose blocks the normal stress-induced increase in adrenal cortisol production for up to 24hrs

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25
Q

Cautions for etomidate

A

Adrenal insufficiency e.g. sepsis

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26
Q

Disadvantage of propofol

A

Can produce hypotension and respiratory depression

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27
Q

Propofol uses

A

Induction or maintenance of anaesthesia in adults & children

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28
Q

Why is propofol useful in conjunction with LMA

A

Reduces airway and pharyngeal reflexes

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29
Q

How to reduce the dose of propofol needed for induction

A

Pre-med with opioid or benzodiazepine

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30
Q

Cautions for propofol

A

Already hypotensive patients

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31
Q

SE of propofol

A

Hypotension
Brady/tachycardia
Arrhythmias
Rash
N&V
Excitation phenomena
Headache
Transient apnoea
Propofol infusion syndrome (more than 4mg /kg/hr - potentially fatal)

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32
Q

Main action of ketamine

A

NMDA receptor antagonist

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33
Q

What can reduce delerium in patients given ketamine?

A

Pre-med with opioid or benzo

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34
Q

Impact of ketamine on the CV system

A

Sympathetic effect
Increased HR, BP and CO

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35
Q

Why does ketamine have a role in asthma?

A

Bronchial smooth muscle relaxant

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36
Q

Contraindictions to ketamine

A

Acute prophyrias
Head trauma
Stroke
Raised ICP
HTN
Severe cardiac disease

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37
Q

SE of ketamine

A

Extraneous muscle movements
Post operative N&V
HTN
Tachycardia
Transient psychotic effects

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38
Q

Contraindictions for NO2

A

Pneumothorax
Intra-cranial air
Recent underwater dive
Recent intraocular gas injection
Intestinal obstruction
Those with / at risk of ICP

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39
Q

Potential SE of NO2

A

Megalobalstic anaemia
Neurological toxic effects
Depression of white cell formation

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40
Q

MOA of benzodiazepines

A

GABA receptor agonists (enhance INHIBITORY synaptic transmission through the CNS)

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41
Q

Uses for benzos

A

Sedative
Hypnotic
Anxiolytic
Anticonvulsant
Muscle relaxant

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42
Q

Benzodiazepines contraindications

Cautions

A

Respiratory depression
Significant neuromuscular resp weakness
OSA
Severe hepatic impairement (elimination half life prolonged)
Phobic or obsessional states, chronic psychosis or hyperkinesis

Respiratory disease
Muscle weakness
Organic brain disease
Severe renal impairment (increased cerebral sensitivity)
Dependent personalitys
Frail / elderly
Hx of drug abuse
On other CNS depressants

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43
Q

Benzodiazepines side effects

A

Drowsy
Confusion
Ataxia
Muscle weakness
Headache
Withdrawl sx
Tolerance / dependence

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44
Q

Benzodiazepines toxicity sx

A

Drowsy
Atxia
Dysarthria
Nystagmus
Rarer - resp depression and coma

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45
Q

Antidose for benzodiazepine toxicity

A

Flumazenil

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46
Q

Duration of action

Midazolam

Lorazepam
Temazepam

Diazepam
Chlordiazepoxide

A

< 6hrs

12-18 hrs

24-48hrs

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47
Q

What type of neuromuscular block is atracurium?

A

Non-depolarising

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48
Q

MOA of atracurium

A

Competes with ACh, binds with receptorrs on postsynapttic membrane

Prevents depolarising and muscle contraction

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49
Q

What effect DOESN’T atracurium have AND why?

A

No sedative or analgesic effect
Nil impact on CNS
Can’t cross the BBB (water soluble)

50
Q

CV SE of atracurium AND why?

How to minimise

A

Flushing, tachycardia, hypotension and bronchospasm

Due to histamine release

Give slowly or in divided doses

51
Q

Cautions for atracurium

A

Myasthenia gravis / syndromes (sensitive to this drug)

52
Q

Reversal agent for atracurium (non depolarising agents)

A

Neostigmine (anticholiesterase)

53
Q

What type of neuromuscular blockade is suxamethonium?

A

Depolarising agent

54
Q

MOA of depolarising agents

A

Produce PERSISTENT depolarisation at the NMJ, bind to ACh receptors but not broken down by acetlycholinesterase

Therefore AP can’t be propigated

55
Q

Reversal of suxamethonium

A

Action can’t be reversed by drugs (neostigmine potentiates(

Recovery is spontaneous (hydrolysed rapidly in 5-10 mins by plasma pseudocholinesterase)

56
Q

Premedication for suxamethonium

A

Glycopyrronium bromide / atropine sulfate reduces the muscarinic effects

57
Q

Fatal complication of suxamethonium

A

Malignant hyperthermia

58
Q

Malignant hyperthermia characterisation

A

Tachycardia, muscle spasms and rapid profound hyperthermia

59
Q

MOA of local anaesthetics

A

Block voltage gated Na+ channeels, preventing generation of action potentials

60
Q

Duration of lidocaine block

A

90 mins

61
Q

What is prilocaine usually used for?

A

IV regional anaesthesia

62
Q

Duration of bupivacaine block

How long does it take to take full effect

A

8hrs
Can take 30 mins to take full effect

63
Q

Impact of LA on blood vessels

A

Dilation

64
Q

Why does adrenaline prolong the anaesthetic effect

A

Vasoconstricts, diminishing local blood flow, slowing the rate of absorption

65
Q

CNS toxicity sx with LA

A

Sedation
Anxiety
Tremor
Visual disturbance
Convlusions
Coma
Resp depression

66
Q

CV toxicity sx with LA

A

Vasodilation
Myocardial depression with bradycardia

67
Q

Examples of live attenuated vaccines (6)

A

BCG,
MMR
varicella-zoster
rotavirus
influenza (nasal)
polio (oral)

68
Q

Examples of inactivated preparation vaccines (4)

A

Hep A
Influenza (IM)
Polio
Pertussis
Rabies

69
Q

Examples of detoxified exotoxin vaccines (2)

A

Tetanus
Diptheria

70
Q

Examples of extract vaccines (4)

A

Men A & C
Pneumococcus
Hib
Hep B

71
Q

How can passive immunity be obtained medically?

A

Injection of immunoglobulins from the plasma of immune individuals

72
Q

Two types of immunoglobulins

A

Normal (nonspecific) - from unselected donors. Hyperimmune (specific) - from selected donors.

73
Q

Examples of disease tx with normal immunoglobulins

A

Hep A
Measles
Rubella

74
Q

Examples of disease tx with specific immunoglobulins

A

Hep B
Rabes
Tetanus
Varicella-zoster r

75
Q

When is immunoglobulins indicated for Hep A (2)

A

Prevention of ix in close contacts of confirmed cases who have / are….

Chronic liver disease
HIV ix
Immunocompromised
50yrs +

OR

Prophylaxis for immunocompromised travelling to high risk areas (where antibody response may be inadequate)

76
Q

When is immunoglobulins indicated for measles?

A

Prevention or attenuation of an attack of measles in those without adequate immunity e.g. Infants < 9 months, non immune pregnant women who have been in contact with a confirmed case / local outbreak

77
Q

Contraindications for normal immunoglobulin therapy?

A

Selective Ig A deficiency who have known antibody against Ig A

78
Q

Indications for Hep B immunoglobulin tx

A

Prevention of ix in a lab setting
Accidental inoculated people
Infants born to infected mothers / high risk carriers

79
Q

Agammaglobulinaemia =

A

lack of gamma globulin in the blood plasma, causing immune deficiency.

80
Q

Hypogammaglobulinemia =

A

A disorder caused by low serum immunoglobulin or antibody levels.

81
Q

Normal immunoglobulin and vaccine timings

A

SHOULD NOT BE GIVEN AT THE SAME TIME

82
Q

Tx of established cases of tetanus?

A

Metronidazole, wound cleansing and immunoglobulin

83
Q

Who is at risk of severe chicken pox?

A

Neonates
Children <1 yr
Pregnant females
Immunosuppressed individuals

84
Q

What is in the BCG vaccine?

A

Live attenuated strain of M.bovis

85
Q

Areas with what incidence of TB should have all neonates & infants vaccinated?

A

40 in 100,000

86
Q

Which children should be given the BCG vaccine regardless of the area they live in?

A

Who have parents or grandparents born in a country where the annual incidence is 40 per 100,000

or if they lived in a country for 3 months or more where the annual incidence is 40 per 100,000

87
Q

What must be confirmed before the BCG vaccine is given?

A

SCID screening

88
Q

At how many days old should eligible babies be given the BCG vaccine?

A

28

89
Q

The HiB vaccine can only be given ….

A

with other vaccines

90
Q

What type of vaccine is the HiB vaccine?

A

Inactivated polysaccharide extracts from cultures

91
Q

What is the first 3 doses of the HiB vaccine as part of?

A

Diptheria with tetanus, pertussis, polio & HiB

92
Q

What is the booster dose of HiB given with?

A

Men C

93
Q

What type of vaccine is the Hep A vacc?

A

Inactive monovalent

94
Q

What type is the MMR vaccine?

A

Live

95
Q

How many MMR vaccines should be given prior to a child entering school?

A

2

96
Q

Which type of insulin is used in DKA?

A

Soluble insulin

97
Q

What makes hydrocortisone unsuitable for disease suppression on a long term basis?

A

High mineralcorticoid activity

98
Q

What type of hormonal activity does prednisolone have?

A

Predominantly glucocorticoid

99
Q

What receptors do antihistamines act on?

A

H1

100
Q

Antihistamine antiemetics

A

Cyclizine

Promethazine

101
Q

MOA of phenothiazines

A

Dopamine antagonists, act centrally by blocking the chemoreceptor trigger zone

102
Q

Examples of phenothiazine antiemetics

A

Chlorpromazine and prochloperazine

103
Q

MOA of opioid medication

A

Prolonged activation of opioid receptors that are distributed with in the CNS

104
Q

IV lorazepam dose in status

1 month - 11 years old

12yrs +

A

100 micrograms / kg (max 4mg)

4mg

105
Q

Which seizure types may phenytoin exacerbate?

A

Absence or myoclonic

106
Q

MOA of carbamazepine, lamotrigine, valproate and phenytoin

A

Block neuronal Na2+ channels, stabilising them in an inactive state

107
Q

Cardiac condition where carbamazepine is contraindicated?

A

AV block

108
Q

Which enzymes do NSAIDs inhibit?

A

COX

109
Q

In patients with what co-morbidities might colchicine be useful?

A

HF

Anticoagulants

110
Q

Main actions of digoxin

A

Positive inotrope and negative chronotrope

111
Q

Digoxin should be used in patients with…

A

Persistent AF
Sedentary

112
Q

Digoxin contraindicated…

A

In any patient with another arrhythmia (e.g. SVT, VF, HB) or hypertrophic cardiomyopathy

113
Q

Cardiac SE of digoxin

A

SA / AV node block
PVCs
PR prolongation
ST depression

114
Q

Visual SE of digoxin

A

Blurred or yellow vision

115
Q

Tx of life threatening digoxin toxicity?

A

Digoxin-specific antibody

116
Q

What do loop diuretics act on?

A

Inhibit the Na+ / K+ / 2Cl- symporter in thick ascending limb, blocks their reabsorption

117
Q

Where do thiazide diuretics act?

A

Apical Na+ / Cl- cotransporter in early distal tubule.

118
Q

Example of an osmotic diuretic

A

Mannitol

119
Q

Osmotic diuretic MOA

A

Increase osmolarity of blood and renal filtrate, so less water is reabsorbed

120
Q

What receptors do K+ sparing diuretics block?

A

Aldosterone, so reducing Na+ reabsorption

121
Q

MOA of carbonic anhydrase inhibitors

A

Reduces HCO3+ reabsorption so weakly reduces water reabsorption

Other MRCEM part 1 (5 decks)

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