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AAA MSRA > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Time passed since ingestion for paracetamol levels?

A

4 hours

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2
Q

How long is NAC infused over & why?

A

1 hour to reduce anaphylactoid reaction (non-IgE mediated mast cell release)

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3
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

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4
Q

Contraindications to viagra

A

patients taking nitrates and related drugs such as nicorandil

hypotension

recent stroke or myocardial infarction (NICE recommend waiting 6 months)

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5
Q

What are the adverse effects of Gentamicin?

A

Ototoxicity & Nephrotoxicity

Contraindication - myasthenia gravis

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6
Q

Drugs causing lung fibrosis

A
  • amiodarone
  • cytotoxic agents: busulphan, bleomycin
  • anti-rheumatoid drugs: methotrexate, sulfasalazine
  • nitrofurantoin
  • ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
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7
Q

Adverse effects of macrolides e.g erythromycin

A

Prolongation of the QT interval

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8
Q

Why should statins be stopped when taking macrolides?

A

Increases the risk of myopathy and rhabdomyolysis

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9
Q

Recommend Adult Life Support (ALS) adrenaline doses

A

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1ml of 1:1000 IV

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10
Q

Inducers of the P450 system

A

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)

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11
Q

Inhibitors of the P450 system include

A

antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin

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12
Q

Adverse effects of Quinolones (ciprofloxacin, levofloxacin)

A

lower seizure threshold in patients with epilepsy

tendon damage (including rupture) - the risk is increased in patients also taking steroids

cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children

lengthens QT interval

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13
Q

Contraindications of Quinolones (ciprofloxacin, levofloxacin)

A

women who are pregnant or breastfeeding

avoid in G6PD

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14
Q

Which medications may exacerbate heart failure

A

thiazolidinediones -
pioglitazone is contraindicated as it causes fluid retention

verapamil -
negative inotropic effect

NSAIDs/glucocorticoids -
should be used with caution as they cause fluid retention,
low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks

class I antiarrhythmics -
flecainide (negative inotropic and proarrhythmic effect)

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15
Q

Side effects of amiodarone

A

Thyroid issues, pulmonary fibrosis, corneal deposits, photosensitivity reactions and derangement in liver function tests.

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16
Q

Most common side effects of Rifampicin

A

Orange bodily fluids, rash, hepatotoxicity, drug interactions

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17
Q

Most common side effects of Isoniazid

A

Peripheral neuropathy, psychosis, hepatotoxicity

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18
Q

Most common side effects of Pyrazinamide

A

Arthralgia, gout, hepatotoxicity, nausea

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19
Q

Most common side effects of Ethambutol

A

Optic neuritis, rash

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20
Q

Most important reason in giving HRT to younger women

A

Preventing the development of osteoporosis

Other benefits include a reduced incidence of colorectal cancer

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21
Q

Why is oestrogen combined with progestogen in a woman with a uterus?

A

to reduce the risk of endometrial cancer

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22
Q

Investigations prior to TB therapy?

A

LFTs
Visual acuity and renal function should also be checked prior to starting ethambutol

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23
Q

What complication may be prevented by the co-prescription of pyridoxine?

A

The risk of peripheral neuropathy with isoniazid can be reduced by prescribing pyridoxine

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24
Q

Signs of lithium toxicity

A

Features of toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

Toxicity may be precipitated by:
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole

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25
Q

Side effects of ACE inhibitors

A

• Cough
• Hyperkalaemia

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26
Q

Side effects of Bendroflumethiazide

A

Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance

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27
Q

Side effects of Calcium channel blockers

A

Headache
Flushing
Ankle oedema

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28
Q

Side effects of Beta-blockers

A

Bronchospasm (especially in asthmatics)
Fatigue
Cold peripheries

29
Q

Side effects of Doxazosin

A

Postural hypotension

30
Q

Side effects of Sulfonylureas e.g. Glicazide

A

Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)

30
Q

Side effects of Gliptins

A

Pancreatitis

30
Q

Side effects of Glitazones

A

Weight gain
Fluid retention
Liver dysfunction
Fractures

31
Q

Drug-induced urinary retention

A

tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide

32
Q

Drugs which can precipitate digoxin toxicity

A

drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

33
Q

Harmful drugs antibiotics i pregnancy

A

Antibiotics
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones: the BNF advises to avoid due to arthropathy in some animal studies

34
Q

Harmful drugs in pregnancy

A

Other drugs
ACE inhibitors, angiotensin II receptor antagonists
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents

The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk

35
Q

Drugs causing photosensitivity

A

thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas

36
Q

Amoxicillin S/E

A

Rash with infectious mononucleosis

37
Q

Co-amoxiclav S/E

A

Cholestasis

38
Q

Flucloxacillin S/E

A

Cholestasis (usually develops several weeks after use)

39
Q

Erythromycin S/E

A

Gastrointestinal upset
Prolongs QT interval

40
Q

Ciprofloxacin S/E

A

Lowers seizure threshold
Tendonitis

41
Q

Metronidazole S/E

A

Reaction following alcohol ingestion

42
Q

Doxycycline S/E

A

Photosensitivity

43
Q

Trimethoprim S/E

A

Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis

44
Q
A
45
Q

Drugs to avoid in renal failure

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

46
Q

Teratogenic effect of Warfarin

A

Craniofacial abnormalities

47
Q

Teratogenic effect of Valproate

A

Neural tube defects
Craniofacial abnormalities

48
Q

Teratogenic effect of Thalidomide

A

Limb reduction defects

49
Q

Teratogenic effect of Tetracyclines

A

Discoloured teeth

50
Q

Teratogenic effect of smoking

A

Preterm labour
Intrauterine growth retardation

51
Q

Teratogenic effect of Maternal diabetes mellitus

A

Maternal diabetes mellitus Macrosomia
Neural tube defects
Polyhydramnios
Preterm labour
Caudal regression syndrome

52
Q

Teratogenic effect of Lithium

A

Ebstein’s anomaly (atrialized right ventricle)

53
Q

Teratogenic effect of Diethylstilbesterol

A

Vaginal clear cell adenocarcinoma

54
Q

Teratogenic effect of Cocaine

A

Intrauterine growth retardation
Preterm labour

55
Q

Teratogenic effect of Chloramphenicol

A

‘Grey baby’ syndrome

56
Q

Teratogenic effect of Carbamazepine

A

Neural tube defects
Craniofacial abnormalities
Chloramphenicol

57
Q

Teratogenic effect of Aminoglycosides

A

Ototoxicity

58
Q

Teratogenic effect of Alcohol

A

Craniofacial abnormalities

59
Q

Teratogenic effect of Ace I

A

Renal dysgenesis
Craniofacial abnormalities

60
Q

Drug-induced thrombocytopenia

A

Drug-induced thrombocytopenia (probable immune-mediated)
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

61
Q

Visual changes secondary to drugs

A

blue vision: Viagra (‘the blue pill’)
yellow-green vision: digoxin

62
Q

Drugs causing ocular problems

A

Cataracts
steroids

Corneal opacities
amiodarone
indomethacin

Optic neuritis
ethambutol
amiodarone
metronidazole

Retinopathy
chloroquine, quinine

Sildenafil can cause both blue discolouration and non-arteritic anterior ischaemic neuropathy

63
Q

Ecstasy poisoning features & management

A

Clinical features
neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA
hyperthermia
rhabdomyolysis

Management
supportive
dantrolene may be used for hyperthermia if simple measures fail

63
Q

Organophosphate insecticide poisoning features & management

A

Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation

Management
atropine
the role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit

64
Q

Tamoxifen adverse effects

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

65
Q

Why is aspirin contraindicated in <16

A

Risk of Reye’s syndrome

66
Q
A

AAA MSRA (4 decks)

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