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Pharmacology Flashcards

1
Q

What electrolye imbalance often precipitates digoxin toxicity

A

Hypokalaemia

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2
Q

Presentation of quinine toxicity

A

Tinnitus
Metabolic acidosis
Flash pulmonary oedema
Visual problems
Hypoglycaemia

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3
Q

ECG finding in quinine toxicity

A

Prolonged QRS

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4
Q

How give opioids initially if patient in acute severe pain

A

IV morphine in 1-2mg boluses until comfortable

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5
Q

Which antibiotics avoid in G6PD

A

Quinolones
Nitrofurantoin
Chloramphenicol
Sulphonamides

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6
Q

How long give HRT for in premature menopause

A

Until 50

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7
Q

Which drugs precipitate lithium toxicity

A

Diuretics
NSAIDs

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8
Q

How differentiate serontonin syndrome from NMS

A

NMS= rigidity, hyporeflexia
SS= hyperreflexia, myoclonus

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9
Q

Drugs which induce P450 system

A

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
chronic alcohol intake
griseofulvin
smoking

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10
Q

Drugs which inhibit P450 system

A

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

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11
Q

When measure phenytoin levels

A

Just before next dose

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12
Q

When measure ciclosporin levels

A

Just before dose

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12
Q

When measure digoxin levels

A

6hrs post dose

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13
Q

Buprenorphine MOA

A

Kappa-opioid receptor antagonism and mu-opioid receptor agonism

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14
Q

How treat anaphylactoid reactions to IV acetylcysteine

A

Stop infusion and restart at lower infusion
Give neb salbutamol too as can cause bronchoconstriction

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15
Q

What is an anaphylactoid reaction

A

Non IgE immune mediated mast cell release

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16
Q

Ciclosporin side effects

A

Everything raised
- K+
- HTN
- glucose
- fluid retention
- gum hypertrophy
Nephro and hepatotoxic

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17
Q

What is given for HER2 positive breast cancer

A

Trastuzumab (herceptin)

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18
Q

Problem of trastuzumab

A

Cardiotoxic

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19
Q

What give if high risk for VTE but severe renal impairement

A

Unfractionated heparin

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20
Q

Which drugs can cause urinary retention

A

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

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21
Q

Presentation of organophosphate poisoning

A

Accumulation of ach
- Salivation
- Lacrimation
- Urination
- Defecation/diarrhoea
- cardiovascular: hypotension, bradycardia
- small pupils

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22
Q

Management of organophosphate poisoning

A

Atropine

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23
Q

Which painkiller can interact with SSRI and cause serotonin syndrome

A

Tramadol

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24
Q

Criteria for liver transplant in paracetamol OD

A

Arterial pH <7.3 24 hours post

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25
Q

Main side effect of taking mag sulph tablets

A

Diarrhoea

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26
Q

Who is diclofenac avoided in

A

Any patient with history of any vascular disease

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27
Q

When stop metformin

A

MI
AKI
Infection
Diarrhoeal illness
Can increase risk of lactic acidosis

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28
Q

How manage adrenaline induced ischaemia

A

Phentolamine

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29
Q

Drug causes of urticaria

A

aspirin
penicillins
NSAIDs
opiates

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30
Q

Organophosphate poisoning presentation

A

DUMBELS’:
D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation

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31
Q

How differentiate chronic lithium use tremor from overdose

A

Fine= chronic use
Coarse= overdose

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32
Q

How give acetylcysteine

A

1 hour infusion

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33
Q

Management of beta blocker OD

A

If bradycardic give atropine

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34
Q

Management of digoxin toxicity

A

Digibind- specific neutralising antibodies for digoxin

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35
Q

How does amiodarone cause hypothyroidism

A

Thought to be due to wolff chaikof effect where levels of thyroxine really high so thyroid stops producing

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36
Q

How does amiodarone cause hyperthyroidism

A

Type 1- excess iodine induced thyroxine synthesis
Type 2- autoimmune destruction of thyroid

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37
Q

How manage type 1 amiodarone induced thyrotoxicosis

A

Carbinmazole

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38
Q

How manage type 2 amiodarone induced thyrotoxicosis

A

Steroids

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39
Q

Lithium toxicity management

A

mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

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40
Q

Ecstasy overdose

A

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

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41
Q

Which antibiotics are ototoxic

A

Aminogylcosides

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42
Q

Which drugs can precipitate digoxin toxicity

A

Amiodarone
Verapamil
Diltiazem
Thiazides
Loop diuretics

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43
Q

Effect of taking alcohol with paracetamol OD

A

Protective as inhibits P450 system

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44
Q

What increases risk of hepatotoxicity in pracetamol OD

A

P450 inducers
Chronic alcoholism
HIV
Malnourished

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45
Q

What effect does inducing or inhibiting the P450 system have on warfarin

A

If induce then enhance clearance meaning becomes less effective so INR will drop

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46
Q

When can use activated charcoal in paracetamol OD

A

If within 1 hour

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47
Q

Digoxin toxicity presenation

A

Unwell
N&V
Anorexia
Confusion
Yellow green vision
Arrythmias
Gynaecomastia

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48
Q

Which overdose presents with yellow green vision

A

Digoxin

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49
Q

Aspirin overdose presentation

A

Hyperventilation
Tinnitus
Glucose abnormalities
Lethargy/confused
N&V

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50
Q

ABG findings in aspirin OD

A

Early resp alkalosis
Followed by metabolic acidosis

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51
Q

Management of aspirin OD

A

Charcoal if early
May need sodium bicarb IV and haemodialysis

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52
Q

How manage iron tablet overdose

A

Desferrioxamine

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53
Q

How manage antifreeze overdose

A

Fomepizole is antidote

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54
Q

What are the 2 potassium sparing diuretics

A

Amiloride
Aldosterone antagonists

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55
Q

How does amiloride work

A

Blocks sodium channels in DCT
Acts as K+ sparing diuretic

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56
Q

What do if develop hypothyroidism on amiodarone

A

Continue amiodarone
Give thyroid replacement

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57
Q

How are organophosphates so poisonous

A

Acetylcholinesterase inhibitors which leads to accumulation of acetylcholine

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58
Q

What must avoid when combining diuretics

A

2 of
- amiloride
- spironolactone
- ACEi
Together

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59
Q

Which antibiotic avoid in seizure patients

A

Quinolones as reduce seizure threshold

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60
Q

What does POM mean on medication

A

Prescription only

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61
Q

LSD toxicity

A

Symptoms
- hallucination
- paranoia
- headache
- palpitations
Obs
- hyperthermia
- hypertension
- tachycardia
- mydriasis

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62
Q

Best option for motion sickness

A

Transdermal hyoscine

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63
Q

Options for motion sickness

A

Transdermal hyoscine 1st line
Cyclizine 2nd line

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64
Q

Side effects of nifedipine and amlodipine

A

Flushing
Ankle swelling
Headache

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65
Q

How are digoxin levels monitored

A

No monitoring unless toxicity suspected

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66
Q

Drugs which can interact to cause serotonin syndrome

A

Triptans
St Johns Wort
MDMA
SSRIs
MAOi
Amphetamines
Tramadol

67
Q

Lithium toxicity precipitants

A

Dehydration
Renal failure
NSAIDs
Diuretics

68
Q

Presentation of cocaine OD

A

Cardio
- arrythmias
- vasospasm
Neuro
- agitation
- seizures
- hypertonia/reflexia
Psychiatric
- psychosis
Ischaemic colitis

69
Q

What need to consider if someone who has taken cocaine presents with abdo pain or rectal bleeding

A

Mesenteric ischaemia

70
Q

Presentation of anti-freeze posioning

A

Like alcohol intoxication- confusion, slurred speech, dizziness
Metabolic acidosis
Tachycardia and HTN
AKI

71
Q

Who is antihistamines CI in

A

HF patients

72
Q

What do with metformin if diarrhoeal illness

A

Suspend as increases risk of lactic acidosis

73
Q

Which CCB most inotropic

A

Verapamil and so most likely to induce HF

74
Q

How manage LSD toxicity

A

For agitation give benzos
May require ITU support

75
Q

Presentation of hypomagnaesaemia

A

Similar to hypocalcaemia

76
Q

If metformin not tolerated due to GI side effects what do

A

Give modified release version

77
Q

Which drug causes corneal opacities

A

Amiodarone

78
Q

Causes of hypomagnesaemia

A

PPIs and diuretics
Alcohol use chronically
Hypercalcacemia
Hypokalaemia

79
Q

Management of paracetamol OD

A

If staggered (over 1 hour) give right away
Ideally measure levels at 4 hours then give if above certain level
If 8-24 hours after and has consumed over 150mg/kg then give
If present over 24 hours after and jaundiced, hepatic tenderness, paracetamol level raised or ALT raised

80
Q

Presentation of GHB (gamma hydroxybutyric acid)

A

Early CNS depression with coma, bradycardia and resp distress
Then quick recovery as short half life

81
Q

What drug intoxication presents with resp depression, coma and then quickly recovers

A

Gamma hydroxbutyric acid

82
Q

Difference between muscarinic and nicotinic receptors

A

Nicotinic receptors are found in the CNS and NMJ
Muscarinic are found in organs

83
Q

What is suxamethonium

A

Nicotinic agonist used as depolarising muscle relaxant

84
Q

What is atracarium

A

Nicotinic antagonist used as non-depolarising muscle relaxant

85
Q

What is a beta 1 agonist

A

Dobutamine used as inotrope

86
Q

GABA agonists

A

Benzos

87
Q

GABA antagonists

A

Flumenazil

88
Q

Serotonin antagonists

A

Ondensatron

89
Q

Alpha antagonist

A

Tamsulosin
Doxazosin for HTN

90
Q

Alpha 1 agonists

A

Phenylephrine used for nasal decongestion

91
Q

Alpha 2 agonists

A

Biromidine used for glaucoma

92
Q

Histamine-1 antagonists

A

Normal anti-histamines like loratadine

93
Q

Histamine-2 antagonists

A

Ranitidine used as antacid

94
Q

Which CCB can you used in HF

A

Amlodipine as little effect on myocardium- more affects peripheral vascular smooth muscle

95
Q

What are the 3 places CCBs can act

A

On voltage gated calcium channels which are present in
- myocardium
- nervous system
- vascular smooth muscle

96
Q

What are the different types of CCB

A

Dihydropyridines which act more on vascular smooth muscle
Verapamil which is very inotropic and acts on heart

97
Q

What are the 2 types of dihydropyridines

A

Short acting- nifedipine
Longeracting- amlodipine

98
Q

What is main side effect of short acting dihydropyridines (nifedipine)

A

Tachycardia as causes peripheral vasodilation

99
Q

Rank CCBS in terms of inotropic ability

A

Most= verapamil- avoid in HF
Diltiazem- used with caution in HF
Dihydropyridines- fine in HF

100
Q

In beta blocker overdose what use

A

Atropine but if resitant can use glucagon

101
Q

How manage methanol posioning

A

Ethanol or fomepizole

102
Q

How manage cyanide poisoning

A

Hydroxycobalamin

103
Q

How manage lead poisoning

A

Dimercaprol

104
Q

How manage CO poisoning

A

100% oxygen
Hyperbaric chamber

105
Q

How long before can increase metformin dose

A

1 week

106
Q

If suspect digoxin toxicity what do

A

Cease medication
Digoxin concentrations should be measured within 8-12 hours of the last dose to assess for the plasma concentration.

107
Q

TCA overdose presentation

A

Anticholinergic effects- mydriasis, dry mouth, blurred vision
If severe- arrythmias, seizures, metabolic acidosis

108
Q

ECG changes in TCA OD

A

sinus tachycardia
widening of QRS
prolongation of QT interval

109
Q

Which HTN drug causes gingival hyperplasia

A

Amlodipine

110
Q

What is caustic substance ingestion

A

Corrosive substance ingesion

111
Q

Management of corrosive substance ingestion

A

A-E
IV PPI
Upper GI endoscopy if symptomatic to assess ulceration with zargar classification

112
Q

Risks of corrosive susbstance ingestion

A

GI ulceration and perforation
Upper airway injury
Aspiration pneumonia
Infection

113
Q

Long term risks of corrosive substance ingestion

A

Strictures, fistulae, gastric outlet obstruction
Upper GI carcinoma (estimated 1000-3000 fold increased risk)

114
Q

MOA of aspirin

A

Non-reversible COX 1 and 2 inhibitor which prevents productino of thromboxane A2

115
Q

Management of heparin induced thrombocytopenia

A

Direct thrombin inhibitor- argatroban

116
Q

What do if taking metformin and need CT with contrast

A

Stop for 48 hours

117
Q

Contraindications for sildenafil

A

Taking nitrates or nicorandil
Stroke or MI within 6 months
Hypotension

118
Q

MOA of UFH vs LMWH

A

Both activate antithrombin III
UFH forms a complex which inhibits factors- Xa, IXa, Xia and XIIa
LMWH forms a complex which inhibits factor Xa

119
Q

Adverse side effects of all heparins

A

Bleeding
Thrombocytopenia
Hyperkalaemia
Osteoporosis

120
Q

Side effects of amiodarone

A

Thyroid- hyper and hypo
Corneal deposits
Pulmonary fibrosis
Photosensitivity
Slate grey
Peripheral neuropathy
Long QT
Bradycardia

121
Q

Best management ofHow give HRT to reduce DVT risk

A

Transdermal combined

122
Q

If someone is found next to a bottle of pills and has jaw clenched with uupward deviation of eyes, what is going on

A

Oculogyric crisis due to metoclopramide or antipschotic intake

123
Q

Management of oculogyric complications

A

Procyclidine

124
Q

Verapamil side effects

A

Bradycardia
HF
Flushing
Constipation

125
Q

A 2-year-old boy is recovering following an uncomplicated appendicectomy, first line analgesia

A

Paracetamol

126
Q

If patient has post mastectomy arm pain what give

A

Pregabalin

127
Q

What must do before giving flecainide

A

Echo to check for structural heart problems

128
Q

Management of hypomagnaseamia

A

Under 0.4 or tetany, arrythmias seizures
- IV mag sulph
Over 0.4
- oral magnesium sulphate salts

129
Q

Side effect of oral mag sulph salts

A

Diarrhoea

130
Q

What monitor with statins

A

LFTs for 1 year

131
Q

What monitor with amiodarone

A

TFT
LFT

132
Q

What monitor with ACEi

A

U&Es annually

133
Q
A
134
Q

What monitor with azathioprine

A

FBC
LFT

135
Q

Maximum dose of paracetamol/day

A

4g

136
Q

If someone is vomiting post op what want to try and do with analgesia

A

IV analgesia

137
Q

Carbon monoxide poisoning presentation

A

Headache- most common
N&V
Flushed skin
Confusion

138
Q

Investigations for CO poisoning

A

Pulse oximetry will be normal
Blood gas necessary
ECG to look for iscahemia

139
Q

What are normal carboxyhaemoglobin levels

A

In smoker <10%
Non-smoker <3%

140
Q

What counts as elevated carboxyhaemoglobin levels

A

Symptomatic 10-30%
Severe toxicity if >30%

141
Q

Indications for haemodialysis in aspirin OD

A

Pulmonary oedema
Severe met acidosis

142
Q

If someone on carbamazepine starts to develop seizures as carbamazepine levels are subtherapeutic, waht is cause

A

Autoinduction of liver cells which have increased clearance

143
Q

Management of bleach intake

A

Asymptomatic
- observe and monitor, IV PPIs
Symptomatic
- IV PPI and endoscopy for early classification with zargar scale

144
Q

If undergo cardiac surgery what medication is given to patients to prevent clotting

A

Heparin

145
Q

Which drug should be administered to normalise a cardiac surgery patients clotting prior to decannulation and chest closure?

A

Protamine sulphate as they are heavily heparinised during surgery

146
Q

A 58-year-old male takes ciclosporin after a recent liver transplant. Two weeks later, he develops flu-like symptoms, a fever of 39ºC, and a reduced urine output. What drugs may cause this presentation?

A

Man is rejecting the liver as ciclosporin levels have been reduced due to induction of P450 system

147
Q

Which NSAID should be avoided in CVD

A

Diclofenac

148
Q

Management of theophylline toxicity

A

Haemodialysis

149
Q

What happens if take allopurinol and azathioprine together

A

Azathioprine toxicity leading to myelosuppression

150
Q

What does a black triangle on a medication mean

A

That it is a new medicine

151
Q

What must do if any side effects are experiences on a medication with black triangle

A

Report immediately

152
Q

What is the yellow card scheme

A

The Yellow Card scheme has become the standard way to report adverse reactions to medications. It is run by the Medicines and Healthcare products Regulatory Agency

153
Q

When should always report something via yellow card scheme

A

All adverse drug reactions on medicines with black triangle
Any adverse reaction in a child
All lifethreating, fatal or disabling adverse reactions in an established drug or vaccine

154
Q

Digoxin MOA

A

Inhibits the Na+/K+ ATPase pump

155
Q

What must be done before starting TB medications

A

LFTs for isoniazid
U&Es and visual acuity for ethambutol

156
Q

What is eGFR cutoff for metformin use

A

30

157
Q

Is HRT contraindicated if migraine history

A

No

158
Q

What drug causes bluish tinge to vision

A

Viagra (bluey)

159
Q

Drug induced thrombocytopenia

A

NSAIDs
diuretics: furosemide
anticonvulsants: carbamazepine, valproate
heparin

160
Q

Can you still get digoxin toxicity if in therapeutic range

A

Yes

161
Q

Complications of illicit opioid misuse

A

VTE
Hepatitis infection
Bacterial infections secondary to injectiing
Overdose
Social problems- prostitution etc

162
Q

Drug causes of pulmonary fibrosis

A

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

163
Q

If a drug is 2%, what does that mean

A

That 2g of the drug are dissolved in 100ml

164
Q
A

Finals (29 decks)

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