Pharmacology Flashcards
1
Q
What electrolye imbalance often precipitates digoxin toxicity
A
Hypokalaemia
2
Q
Presentation of quinine toxicity
A
Tinnitus
Metabolic acidosis
Flash pulmonary oedema
Visual problems
Hypoglycaemia
3
Q
ECG finding in quinine toxicity
A
Prolonged QRS
4
Q
How give opioids initially if patient in acute severe pain
A
IV morphine in 1-2mg boluses until comfortable
5
Q
Which antibiotics avoid in G6PD
A
Quinolones
Nitrofurantoin
Chloramphenicol
Sulphonamides
6
Q
How long give HRT for in premature menopause
A
Until 50
7
Q
Which drugs precipitate lithium toxicity
A
Diuretics
NSAIDs
8
Q
How differentiate serontonin syndrome from NMS
A
NMS= rigidity, hyporeflexia
SS= hyperreflexia, myoclonus
9
Q
Drugs which induce P450 system
A
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
chronic alcohol intake
griseofulvin
smoking
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
11
Q
When measure phenytoin levels
A
Just before next dose
12
Q
When measure ciclosporin levels
A
Just before dose
12
Q
When measure digoxin levels
A
6hrs post dose
13
Q
Buprenorphine MOA
A
Kappa-opioid receptor antagonism and mu-opioid receptor agonism
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
15
Q
What is an anaphylactoid reaction
A
Non IgE immune mediated mast cell release
16
Q
Ciclosporin side effects
A
Everything raised
- K+
- HTN
- glucose
- fluid retention
- gum hypertrophy
Nephro and hepatotoxic
17
Q
What is given for HER2 positive breast cancer
A
Trastuzumab (herceptin)
18
Q
Problem of trastuzumab
A
Cardiotoxic
19
Q
What give if high risk for VTE but severe renal impairement
A
Unfractionated heparin
20
Q
Which drugs can cause urinary retention
A
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
21
Q
Presentation of organophosphate poisoning
A
Accumulation of ach
- Salivation
- Lacrimation
- Urination
- Defecation/diarrhoea
- cardiovascular: hypotension, bradycardia
- small pupils
22
Q
Management of organophosphate poisoning
A
Atropine
23
Q
Which painkiller can interact with SSRI and cause serotonin syndrome
A
Tramadol
24
Criteria for liver transplant in paracetamol OD
Arterial pH <7.3 24 hours post
25
Main side effect of taking mag sulph tablets
Diarrhoea
26
Who is diclofenac avoided in
Any patient with history of any vascular disease
27
When stop metformin
MI
AKI
Infection
Diarrhoeal illness
Can increase risk of lactic acidosis
28
How manage adrenaline induced ischaemia
Phentolamine
29
Drug causes of urticaria
aspirin
penicillins
NSAIDs
opiates
30
Organophosphate poisoning presentation
DUMBELS':
D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation
31
How differentiate chronic lithium use tremor from overdose
Fine= chronic use
Coarse= overdose
32
How give acetylcysteine
1 hour infusion
33
Management of beta blocker OD
If bradycardic give atropine
34
Management of digoxin toxicity
Digibind- specific neutralising antibodies for digoxin
35
How does amiodarone cause hypothyroidism
Thought to be due to wolff chaikof effect where levels of thyroxine really high so thyroid stops producing
36
How does amiodarone cause hyperthyroidism
Type 1- excess iodine induced thyroxine synthesis
Type 2- autoimmune destruction of thyroid
37
How manage type 1 amiodarone induced thyrotoxicosis
Carbinmazole
38
How manage type 2 amiodarone induced thyrotoxicosis
Steroids
39
Lithium toxicity management
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
40
Ecstasy overdose
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
41
Which antibiotics are ototoxic
Aminogylcosides
42
Which drugs can precipitate digoxin toxicity
Amiodarone
Verapamil
Diltiazem
Thiazides
Loop diuretics
43
Effect of taking alcohol with paracetamol OD
Protective as inhibits P450 system
44
What increases risk of hepatotoxicity in pracetamol OD
P450 inducers
Chronic alcoholism
HIV
Malnourished
45
What effect does inducing or inhibiting the P450 system have on warfarin
If induce then enhance clearance meaning becomes less effective so INR will drop
46
When can use activated charcoal in paracetamol OD
If within 1 hour
47
Digoxin toxicity presenation
Unwell
N&V
Anorexia
Confusion
Yellow green vision
Arrythmias
Gynaecomastia
48
Which overdose presents with yellow green vision
Digoxin
49
Aspirin overdose presentation
Hyperventilation
Tinnitus
Glucose abnormalities
Lethargy/confused
N&V
50
ABG findings in aspirin OD
Early resp alkalosis
Followed by metabolic acidosis
51
Management of aspirin OD
Charcoal if early
May need sodium bicarb IV and haemodialysis
52
How manage iron tablet overdose
Desferrioxamine
53
How manage antifreeze overdose
Fomepizole is antidote
54
What are the 2 potassium sparing diuretics
Amiloride
Aldosterone antagonists
55
How does amiloride work
Blocks sodium channels in DCT
Acts as K+ sparing diuretic
56
What do if develop hypothyroidism on amiodarone
Continue amiodarone
Give thyroid replacement
57
How are organophosphates so poisonous
Acetylcholinesterase inhibitors which leads to accumulation of acetylcholine
58
What must avoid when combining diuretics
2 of
- amiloride
- spironolactone
- ACEi
Together
59
Which antibiotic avoid in seizure patients
Quinolones as reduce seizure threshold
60
What does POM mean on medication
Prescription only
61
LSD toxicity
Symptoms
- hallucination
- paranoia
- headache
- palpitations
Obs
- hyperthermia
- hypertension
- tachycardia
- mydriasis
62
Best option for motion sickness
Transdermal hyoscine
63
Options for motion sickness
Transdermal hyoscine 1st line
Cyclizine 2nd line
64
Side effects of nifedipine and amlodipine
Flushing
Ankle swelling
Headache
65
How are digoxin levels monitored
No monitoring unless toxicity suspected
66
Drugs which can interact to cause serotonin syndrome
Triptans
St Johns Wort
MDMA
SSRIs
MAOi
Amphetamines
Tramadol
67
Lithium toxicity precipitants
Dehydration
Renal failure
NSAIDs
Diuretics
68
Presentation of cocaine OD
Cardio
- arrythmias
- vasospasm
Neuro
- agitation
- seizures
- hypertonia/reflexia
Psychiatric
- psychosis
Ischaemic colitis
69
What need to consider if someone who has taken cocaine presents with abdo pain or rectal bleeding
Mesenteric ischaemia
70
Presentation of anti-freeze posioning
Like alcohol intoxication- confusion, slurred speech, dizziness
Metabolic acidosis
Tachycardia and HTN
AKI
71
Who is antihistamines CI in
HF patients
72
What do with metformin if diarrhoeal illness
Suspend as increases risk of lactic acidosis
73
Which CCB most inotropic
Verapamil and so most likely to induce HF
74
How manage LSD toxicity
For agitation give benzos
May require ITU support
75
Presentation of hypomagnaesaemia
Similar to hypocalcaemia
76
If metformin not tolerated due to GI side effects what do
Give modified release version
77
Which drug causes corneal opacities
Amiodarone
78
Causes of hypomagnesaemia
PPIs and diuretics
Alcohol use chronically
Hypercalcacemia
Hypokalaemia
79
Management of paracetamol OD
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
Presentation of GHB (gamma hydroxybutyric acid)
Early CNS depression with coma, bradycardia and resp distress
Then quick recovery as short half life
81
What drug intoxication presents with resp depression, coma and then quickly recovers
Gamma hydroxbutyric acid
82
Difference between muscarinic and nicotinic receptors
Nicotinic receptors are found in the CNS and NMJ
Muscarinic are found in organs
83
What is suxamethonium
Nicotinic agonist used as depolarising muscle relaxant
84
What is atracarium
Nicotinic antagonist used as non-depolarising muscle relaxant
85
What is a beta 1 agonist
Dobutamine used as inotrope
86
GABA agonists
Benzos
87
GABA antagonists
Flumenazil
88
Serotonin antagonists
Ondensatron
89
Alpha antagonist
Tamsulosin
Doxazosin for HTN
90
Alpha 1 agonists
Phenylephrine used for nasal decongestion
91
Alpha 2 agonists
Biromidine used for glaucoma
92
Histamine-1 antagonists
Normal anti-histamines like loratadine
93
Histamine-2 antagonists
Ranitidine used as antacid
94
Which CCB can you used in HF
Amlodipine as little effect on myocardium- more affects peripheral vascular smooth muscle
95
What are the 3 places CCBs can act
On voltage gated calcium channels which are present in
- myocardium
- nervous system
- vascular smooth muscle
96
What are the different types of CCB
Dihydropyridines which act more on vascular smooth muscle
Verapamil which is very inotropic and acts on heart
97
What are the 2 types of dihydropyridines
Short acting- nifedipine
Longeracting- amlodipine
98
What is main side effect of short acting dihydropyridines (nifedipine)
Tachycardia as causes peripheral vasodilation
99
Rank CCBS in terms of inotropic ability
Most= verapamil- avoid in HF
Diltiazem- used with caution in HF
Dihydropyridines- fine in HF
100
In beta blocker overdose what use
Atropine but if resitant can use glucagon
101
How manage methanol posioning
Ethanol or fomepizole
102
How manage cyanide poisoning
Hydroxycobalamin
103
How manage lead poisoning
Dimercaprol
104
How manage CO poisoning
100% oxygen
Hyperbaric chamber
105
How long before can increase metformin dose
1 week
106
If suspect digoxin toxicity what do
Cease medication
Digoxin concentrations should be measured within 8-12 hours of the last dose to assess for the plasma concentration.
107
TCA overdose presentation
Anticholinergic effects- mydriasis, dry mouth, blurred vision
If severe- arrythmias, seizures, metabolic acidosis
108
ECG changes in TCA OD
sinus tachycardia
widening of QRS
prolongation of QT interval
109
Which HTN drug causes gingival hyperplasia
Amlodipine
110
What is caustic substance ingestion
Corrosive substance ingesion
111
Management of corrosive substance ingestion
A-E
IV PPI
Upper GI endoscopy if symptomatic to assess ulceration with zargar classification
112
Risks of corrosive susbstance ingestion
GI ulceration and perforation
Upper airway injury
Aspiration pneumonia
Infection
113
Long term risks of corrosive substance ingestion
Strictures, fistulae, gastric outlet obstruction
Upper GI carcinoma (estimated 1000-3000 fold increased risk)
114
MOA of aspirin
Non-reversible COX 1 and 2 inhibitor which prevents productino of thromboxane A2
115
Management of heparin induced thrombocytopenia
Direct thrombin inhibitor- argatroban
116
What do if taking metformin and need CT with contrast
Stop for 48 hours
117
Contraindications for sildenafil
Taking nitrates or nicorandil
Stroke or MI within 6 months
Hypotension
118
MOA of UFH vs LMWH
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
Adverse side effects of all heparins
Bleeding
Thrombocytopenia
Hyperkalaemia
Osteoporosis
120
Side effects of amiodarone
Thyroid- hyper and hypo
Corneal deposits
Pulmonary fibrosis
Photosensitivity
Slate grey
Peripheral neuropathy
Long QT
Bradycardia
121
Best management ofHow give HRT to reduce DVT risk
Transdermal combined
122
If someone is found next to a bottle of pills and has jaw clenched with uupward deviation of eyes, what is going on
Oculogyric crisis due to metoclopramide or antipschotic intake
123
Management of oculogyric complications
Procyclidine
124
Verapamil side effects
Bradycardia
HF
Flushing
Constipation
125
A 2-year-old boy is recovering following an uncomplicated appendicectomy, first line analgesia
Paracetamol
126
If patient has post mastectomy arm pain what give
Pregabalin
127
What must do before giving flecainide
Echo to check for structural heart problems
128
Management of hypomagnaseamia
Under 0.4 or tetany, arrythmias seizures
- IV mag sulph
Over 0.4
- oral magnesium sulphate salts
129
Side effect of oral mag sulph salts
Diarrhoea
130
What monitor with statins
LFTs for 1 year
131
What monitor with amiodarone
TFT
LFT
132
What monitor with ACEi
U&Es annually
133
134
What monitor with azathioprine
FBC
LFT
135
Maximum dose of paracetamol/day
4g
136
If someone is vomiting post op what want to try and do with analgesia
IV analgesia
137
Carbon monoxide poisoning presentation
Headache- most common
N&V
Flushed skin
Confusion
138
Investigations for CO poisoning
Pulse oximetry will be normal
Blood gas necessary
ECG to look for iscahemia
139
What are normal carboxyhaemoglobin levels
In smoker <10%
Non-smoker <3%
140
What counts as elevated carboxyhaemoglobin levels
Symptomatic 10-30%
Severe toxicity if >30%
141
Indications for haemodialysis in aspirin OD
Pulmonary oedema
Severe met acidosis
142
If someone on carbamazepine starts to develop seizures as carbamazepine levels are subtherapeutic, waht is cause
Autoinduction of liver cells which have increased clearance
143
Management of bleach intake
Asymptomatic
- observe and monitor, IV PPIs
Symptomatic
- IV PPI and endoscopy for early classification with zargar scale
144
If undergo cardiac surgery what medication is given to patients to prevent clotting
Heparin
145
Which drug should be administered to normalise a cardiac surgery patients clotting prior to decannulation and chest closure?
Protamine sulphate as they are heavily heparinised during surgery
146
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?
Man is rejecting the liver as ciclosporin levels have been reduced due to induction of P450 system
147
Which NSAID should be avoided in CVD
Diclofenac
148
Management of theophylline toxicity
Haemodialysis
149
What happens if take allopurinol and azathioprine together
Azathioprine toxicity leading to myelosuppression
150
What does a black triangle on a medication mean
That it is a new medicine
151
What must do if any side effects are experiences on a medication with black triangle
Report immediately
152
What is the yellow card scheme
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
When should always report something via yellow card scheme
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
Digoxin MOA
Inhibits the Na+/K+ ATPase pump
155
What must be done before starting TB medications
LFTs for isoniazid
U&Es and visual acuity for ethambutol
156
What is eGFR cutoff for metformin use
30
157
Is HRT contraindicated if migraine history
No
158
What drug causes bluish tinge to vision
Viagra (bluey)
159
Drug induced thrombocytopenia
NSAIDs
diuretics: furosemide
anticonvulsants: carbamazepine, valproate
heparin
160
Can you still get digoxin toxicity if in therapeutic range
Yes
161
Complications of illicit opioid misuse
VTE
Hepatitis infection
Bacterial infections secondary to injectiing
Overdose
Social problems- prostitution etc
162
Drug causes of pulmonary fibrosis
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
163
If a drug is 2%, what does that mean
That 2g of the drug are dissolved in 100ml
164
