Pharmacology Flashcards
Which antibiotics act on the 30s Ribosome?
- Aminoglycosides,
- Tetracyclines,
- Tigecycline
Which antibiotics act on the 50s ribosome?
- Chloramphenicol,
- clindamycin,
- linezolid,
- macrolides,
- streptogramins
Which antibiotics act on the metabolic pathways (aka folate synthesis)?
Sulphonamides, trimethoprim
Which antibiotics act on nucleic acid synthesis (3)?
- Fluoroquinolones,
- Metronidazole,
- Rifamycins
Which antibiotics act on membrane stability?
Polymyxin, daptomycin
Which antibiotics act on cell wall synthesis?
Beta-lactams (penicillin’s, cephalosporins, carbapenems, monobactams), bacitracin, glycopeptides
What are the SEs of drinking alcohol whilst taking metronidazole? How long should you wait after finishing a course before drinking?
N+V, skin flushing, headaches, abdo pain, tachycardia.
48 hours.
Ciprofloxacin and levofloxacin are what class of antibiotic?
Fluoroquinolones: act on nucleic acid synthesis.
Why is nitrofurantoin CI in G6PD pts?
Can trigger a haemolytic crisis
Why do pts on long term nitrofurantoin require lung function monitoring?
Can cause pulmonary fibrosis with long-term use.
Under what eGFR is nitrofurantoin CI? What should you give instead fpr UTIs?
<45: give them trimethoprim
Why does trimethoprim cause a false rise in creatinine? What electrolyte may rise?
It competes with creatinine for excretion in the kidney causing it to rise in the absence of AKI.
K+ can also go up: this is true do not ignore.
What is co-trimoxazole a combination of? What are the common SEs?
Trimethoprim and sulfamethoxazole.
SEs: diarrhoea, nausea, electrolyte disturbance, headache, fungal overgrowth, skin reactions.
Gentamicin is what type of antibiotic? What should be measured between 18-24 hours after dose? How does this affect management?
Aminoglycosides: measure trough levels.
If trough is high increase time between doses, if peak is high decrease dose.
What is a key SE of gentamicin?
Ototoxicity
How does demeclocycline (tetracycline) affect the collecting duct?
Decreases responsiveness to ADH (nephrogenic DI)
What is 1st line for cholera?
Doxycycline
What macrolide is associated with dyspepsia?
Clarithromycin.
In the case of ESBL producing bacteria, which antibiotic should be used?
Carbepenems such as meropenem
How might co-amoxiclav affect LFTS?
ALP, bilirubin and transaminases may be raised
What is 1st line for septic arthritis?
Flucloxacillin IV: good penetration of joints and treats staph.A which is the most common cause
At what point do you measure the trough levels of vancomycin? How does this affect doasage?
From the 3rd dose: if too low increase dose, if too high increase time between doses
What route is vancomycin given by?
IV unless treating C.Diff
When do you measure teicoplanin trough levels?
6-8 days after starting so less relevant to those on short courses.
What are the side effects of isoniazid?
peripheral neuropathy, liver toxicity
Why would someone who has been treated with parenteral chloramphenicol experience bleeding/bruising and recurrent illness?
Chloramphenicol can cause aplastic anaemia and other blood dyscrasias, especially when used parenterally.
What are the side effects of rifampicin?
Orange secretions, haemolysis, p450 inducer, liver toxicity
What are the side effects of ethambutol?
loss of visual acuity, colour blindness (especially red and green), kidney toxicity,
What are the side effects of pyrazinamide?
Most likely (out of TB drugs) to cause liver toxicity, hyperuricaemia (>7) and therefore can trigger gout, arthralgia,
What is first line for athlete’s foot?
Topical Terbinafine
What is the MOA of oseltamivir? When is it used?
Neuraminidase inhibitor used to help the sx of flu in pts with significant comorbidities.
What are the does for Oseltamivir in flu in adults? How long is the dose?
< 41kg is 60 mg.
>41 kg is 75 mg.
5 days for immunocompetent, 10 days for immunocompromised.
Diarrhoea is a SE of which commonly used T2DM medication?
Metformin
How do sulfonylureas work? What is a major SE?
Stimulate the release of insulin from beta cells. Therefore can cause hypoglycaemia.
‘zides’ e.g., glipizide
Pioglitazone is is associated with what SE which leads to SOB?
Fluid retention
What is 1st line for diabetic neuropathy?
Pregabalin, duloxetine, or gabapentin.
How do manage insulin dosage in pts around surgery?
stop short acting insulin once pt is NBM, continue long acting at a reduced rate such as 80%.
How do you manage a severe hypoglycaemic episode where the pt is unconscious and you have IV access?
IV Glucose:
- 75-100ml of 20%
- 150-200ml of 10%
How do you manage a severe hypoglycaemic episode where the pt is unconscious and you DO NOT have IV access?
IM glucagon
How do you manage a hypoglycaemic episode where the pt is conscious?
Buccal gluogel if not able to eat or any fast acting carb if they can eat
What is the difference between a mineralocorticoid and a glucocorticoid?
M: mimic aldosterone, regulate blood volume and pressure.
G: mimic cortisol, aka corticosteroids, regulate immune cells and glucose response
Long-term effects of steroids?
Osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastro/hepatic/ophthalmological effects, hyperlipidaemia, growth suppression.
Corticosteroids can cause disfunction of what immune cells?
Leucocytosis: increased WCC not related to infection
How do you define steroid-induced diabetes? Mx?
Glucose >12mmol/L twice over 24 hours whilst taking steroids.
Mx- gliclazide
What is 1st line for absence seizures?
Ethosuximide
What is 1st line for tonic-clonic seizures?
Na Valproate or lamotrigine/levetiracetam if this is not appropriate.
What are the SEs of Na Valproate?
VALPROATE:
- Vomiting
- Anorexia
- Liver toxicity
- Pancytopenia and pancreatitis
- Retention of fat (weight gain)
- Oedema
- Alopecia
- Tremor + Teratogenicicty
- Enzyme inhibition
What is 1st line for Myoclonic Seizures?
Na Valproate or levetiracetam if this is not appropriate.
Which seizure medications can worsen absence and myoclonic seizures?
Carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, pregabalin, tiagabine, vigabatrin.
What is 1st line for atonic seizures?
Na Valproate or lamotrigine if this is not appropriate.
What is the MOA for levetiracetam?
Binds to SV2A vesicle in protein in the brain and modulates synaptic NTM release.
What is the MOA for lamotrigine? What severe complication should be monitored for when first starting the drug?
Na channel blocker.
Stevens-Johnson Syndrome.
What is first line for focal seizures?
Levetiracetam or lamotrigine
What is the MOA of carbamazepine? When is it used?
Stabilises electric signals and reduces glutamate release.
Used for trigeminal neuralgia, bipolar I disorder, and epilepsy syndromes:
- Partial seizures
- Generalised tonic clonic (grand mal) seizures
- Some mixed seizure patterns
When should pharmacotherapy be commenced during seizures?
> 5 minutes (when status is reached)
What is first, second, and third line for status epilepticus?
1) benzodiazepine (lorazepam) which can be given twice
2) IV phenytoin infusion
3) General anaesthetic (Propofol or thiopental)
What medication can be used post traumatic brain injury to prevent seizures?
Phenytoin (often 7 days post TBI).
Measure plasma levels throughout 7 days and if it doesn’t meet therapeutic threshold then increase dose.
What is the MOA of Phenytoin?
Voltage gated sodium channel inhibitor.
What medications can lower the seizure threshold?
Antis:
- Antibiotics: imipenem, penicillin’s, cephalosporins, metronidazole, isoniazid
- Antipsychotics
- Antidepressants: bupropion, tricyclics, venlafaxine
- Antihistamines
Pain:
- Fentanyl
- Ketamine
- Lidocaine
- Tramadol
Psych:
- lithium
Why must a quantiferon test be completed before commencing biologics?
They can reactivate latent TB
What is the MOA of colchicine? SEs?
Reduced inflammation by reducing microtubule assembly.
SEs: GI (N, V, D)
What cytotoxic therapy is associated with haemorrhagic cystitis?
Cyclophosphamide
Which chemotherapy agent is associated with peripheral neuropathy?
Vinblastine
Which chemotherapy agent is associated with dilated cardiomyopathy and subsequent heart failure?
Doxorubicin
Which chemotherapy agent is associated with pulmonary fibrosis?
Bleomycin
Which chemotherapy agent is associated with neurotoxicity?
Asparaginase
MOA of imatinib? What is it used for?
TKI (tyrosine kinase inhibitor) used for CML and GI stromal tumours.
What is PD-1 and PDL-1 therapy?
Programmed cell death receptor/ligand is targets. The monoclonal antibody binds to these, initiating cell death of these cells
How long do patch medications take to reach the required dose?
24 hours
How long does it take for a syringe driver (SC) to reach desired systemic concentration?
4 hours
What is used for rapid tranq in Parkinson’s pts? What is CI?
PR/PO lorazepam.
Haloperidol is CI!!
What are the SEs of dopamine precursors such as levodopa?
N+V, orthostatic hypotension, vivid dreams, and hallucinations.
Which Parkinson’s drug is CI in those with pre-existing impulse control disorders?
Dopamine agonists such as pramipexole.
What is Co-careldopa composed of? Why is this beneficial?
Levadopa + carbidopa.
The carbidopa increases bioavailability of levadopa, reducing peripheral breakdown.
When do you manage Hypokalaemia? How? At what rate can you replace K+?
When K+ falls below 2.5mmol/L.
Give 0.9% NaCL + 4 mmol KCL and check magnesium as a low K+ is associated with a low magnesium.
You can replace at a maximum of 10mmol/hr
How do you manage Hyperkalaemia?
- Calcium carbonate
- Insulin/dextrose
- Lokelma?
- Salbutamol?
How do you manage malignant hypercalacaemia?
- Fluids
- Bisphosphonates (e.g., pamidronate)
How do you manage hypocalcaemia? What needs monitoring?
Calcium carbonate and calcitriol.
Monitor ECG as can cause prolonged QT/arrhythmias.
How/ when do you manage hyponatreamia?
<125 mmol/L:
Hypovolaemic -hypertonic saline (slowly)
Hypervolaemic - Fluid restrict
How do you manage hypernatremia?
Hypotonic fluid such as 5% dextrose, give slowly to avoid cerebral oedema.
Do not exceed correction of >10mmol/L over 24 hours.
What are the sx of lithium toxicity? Mx?
Disturbance to CNS: dysarthria, seizures, impaired coordination.
IV fluid therapy.
What are the sx of clozapine toxicity? By what mechanism does this happen?
Confusion, agitation, drowsiness, ataxia, tachycardia.
It is metabolised by CYP450 so anything causing downregulation of this will lead to a build up.
What are the signs/sx of Tricyclic antidepressants OD? What happens on ECG? Mx?
Anticholinergic sx: tachycardia, hypotension, flushing, urinary/bowel incontinence, blurred vision, respiratory depression, coma.
You also get QRS widening due to Na channel blockade.
Mx- IV Na bicarb to raise serum pH and alkalisation favours the neutral form of the drug.
What is 1st and 2nd line for pharmacological management of ADHD?
1) Methylphenidate
2) Atomoxetine
What are the SEs of methylphenidate?
Appetite suppression causing growth suppression.
What is more likely to cause SEs: 1st or 2nd generation antipsychotics?
Second (olanzapine, quetiapine, clozapine, risperidone).
Why do SSRIs cause a euvolaemic hyponatraemia?
Can cause SIADH so you get low serum osmolality, high urine osmolality, and a high urinary sodium.
Which SSRI is associated with priaprism?
Trazadone due to a-adrenergic blocking activity.
What changes can SSRIs make to ECGs?
QT prolongation
Why may someone on an SSRI present with maleena?
They carry a risk of peptic ulcer disease and therefore upper GI bleeding.
How often should methotrexate pts have a FBC done? Why?
Every 1-2 weeks until therapy is stabilised, then every 2-3 months after that.
Can cause bone marrow suppression.
What are the SEs of ciclosporin?
Diarrhoea, hypertrophy of the gums, hypertrichosis, hypertension, hyperkalaemia, hyperglycaemia (diabetes).
Why are pts who carry an epipen CI to have labetalol?
Combined causes a hypertensive crisis as beta blockers.
When is the dose/conc of adrenaline for anaphylaxis adult vs child?
IM in injection conc of 1:1000…
<6 months: 100-150 micrograms
6 months to 5 years: 150 micrograms
6-11 years: 300 micrograms ‘
>12: 500 micrograms
How long prior to surgery should the COCP be stopped? Why?
4 weeks prior to reduce risk of thromboembolic disease.
What is the absolute CI to HRT?
Personal hx of breast or ovarian cancer
Why is transdermal oestrogen better than oral?
Oral increases risk of CVD, PVD, cholestasis/gallstones
Why must women with uteri take progesterone with their HRT?
To protect their endometrium
When would you do cyclical HRT? What does this involve?
Still having periods or final MP was <12months ago.
2 weeks on progesterone, 2 weeks off progetserone.
Continuous oestrogen.
When can a lady have continuous HRT?
Once she has reached the day of menopause (12 months after last MP).
What factors does warfarin act on?
10, 9, 7, 2 (vitamin K dependent factors)
How should warfarin pts be managed around surgery?
Stop a few days before (or reverse if emergent) and bridge with heparin if at risk of thromboembolic disease.
How should warfarin pts who present with bleeding or suspected intracranial bleed be managed?
Stop warfarin and reverse (IV vitamin K and PT complex).
How should warfarin pts who present with an INR between 5-8 but no signs of bleeding be managed?
Stop warfarin until INR stabilises.
How should warfarin pts who present with INR >8 but no signs of bleeding be managed?
Stop warfarin and commence oral vit K.
Where does heparin act in the coagulation cascade?
Inactivates thrombin (activated factor 2) and activated factor 10.
What type of heparin is used in pts with a GFR <30?
Unfractionated.
What has the longest 1/2 life: LMW heparin, unfractionated heparin, or fondaparinux?
Fondaparinux.
Dabigatran acts where in the coagulation cascade? How is it reversed?
FIIa (thrombin) inhibitor.
Idarucizumab.
Apixaban and Edoxaban are what type of anticoagulants? Which is better in someone with declining renal function?
DOACs.
Edoxaban is preferred.
Where do apixaban and rivoroxaban work in the coagulation cascade?
Inhibits FXa.
Edoxaban acts where in the coagulation cascade?
Inhibits prothrombinase.
What does aspirin inhibit?
Cyclooxygenase 1
What are the manifestations of an aspirin OD? What type of pH abnormality to you get?
Hyperpnoea (deep breathing), tinnitus, N+V.
Raised anion gap metabolic acidosis with some respiratory alkalosis and raised base excess.
How do you manage aspirin OD?
Mx-
Activated charcoal of within 1 hour,
Na bicarb to alkalise urine and favour excretion,
Haemodialysis if:
- serum level >700
- severe metabollic acidosis
- seizures/coma
What are the three PY12 inhibitors?
Clopidogrel, prasugrel, ticagrelor
Which PY12 inhibitor has a side effect of ‘air hunger’?
Ticagrelor
What is the MOA of dipyridamole? What is it used for?
PDE3 enzyme inhibitor.
Secondary prevention of ischaemic stroke.
What is the dose and conc of adrenaline issued in cardiac arrest?
300mg 1:10000
What is the MOA of amiodarone?
Blocks Na channels which usually cause repolarisation in the 3rd phase of the cardiac AP, therefore preventing repolarisation.
Why is amiodarone CI in breastfeeding women?
Toxic effects of iodine on infants (infant hypothyroidism).
What is the MOA of digoxin?
Inhibits Na/K adenosine triphosphatase ion pump in myocardium and exhibits parasympathetic effects on the AV node. So it slows the heart and increases contractility.
What are the signs of digoxin toxicity? Mx?
Palpitations/bradycardia/arrhythmia, dyspnoea, GI sx, visual sx.
Mx- digibind.
What electrolyte imbalance most often precipitates digoxin toxicity?
Hypokalaemia.
What is the starting doses for primary and secondary prevention with atorvastatin? When are pts advised to take them?
P- 20mg OD
S- 80mg OD
Take at night as this is when most cholesterol synthesis occurs.
Propranolol, labetalol, and atenolol are what type of medications? What are the known SEs?
Beta blockers: antagonise B1 receptors.
SEs- bradycardia, reflex tachycardia when stopped, can worsen PVD, GI upset, sleep disturbance
What is used to manage benign essential tremours?
Propranolol
What is 1st line for Pre-eclampsia?
Labetalol
What is the MOA for CCBs? What are the two types? Which is used for HeTN?
Block the L type Calcium channels to stop/reduce vascular contraction = decrease afterload.
Dihydropyridine: Amlodipine and Nifedipine - used for HeTN.
Non-dihydropyridine: Diltiazem and Verapamil - more cardio selective.
What are the SEs of CCBs?
hypotension, reflex tachycardia when stopped, ankle oedema, hot flushes, headaches, constipation, relfux
What class of medications are Ramipril and lisinopril? What is the MOA?
ACEis = Reduced ACE = reduced conversion of angiotensin I to angiotensin II (which vasoconstricts vessels) = decreased wall stress and decreased afterload.
What are the SEs of ACEis? Why do they occur?
Dry cough, hepatotoxicity, hyperkalaemia due to increase in bradykinin (usually inactivated by ACE).
What type of medication are candesartan and losartan? Why is there less SEs than ACEis? What SE does it still cause?
ARBs = block angiotensin II receptor to decrease its effect = decreased afterload. Does not impact ACE and therefore does not cause increase in bradykinin = less SEs.
Hyperkalaemia.
In who are ARBs CI?
Pregnant women
Nimodipine is a dihydropyridine CCB used for what medical emergency?
Preventing vasospasm induced cerebral ischaemia in subarachnoid haemorrhage due to ruptures intracranial aneurysms.
What is the MOA of Bosentan? What must be monitored when taking this medication? CIs?
Endothelin A receptor antagonist to reduce vasoconstriction and reduce BP.
Must monitor LFTs as can rarely cause liver injury and is therefore CI in pts with moderate-severe hepatic impairment.
What is the MOA of Midodrine? What is it used for?
Alpha1 agonist used for significant orthostatic HoTN.
What is used to manage low and high risk essential thrombocythaemia?
Hydroxycarbamide (type of chemo) for high, aspirin for low.
What is used to manage Von Willebrand Disease?
Desmopressin (increases release of VWF)
What type of drug is Tranexamic acid? Who is it CI in?
Anti-fibrinolytic.
CI in haematuria.
How does Emicizumab work?
It brings together Factor X and Factor IX to replace the function of Factor XIII.
Used for Factor XIII deficiencies.
What is given in open angle glaucoma?
Prostaglandin E1: Lantoprost - to improve uveoscleral outflow by increasing the sclera’s permeability to aqueous humour.
What is used to maintain a PDA in transposition of the great vessles? What else is it used for?
Prostaglandin E1: alprostadil.
Also used for erectile dysfunction.
What is 1st and 2nd line for urge incontinence?
1) Oxybutynin
2) Mirabegron: for those CI such as those with cataracts
Pyridostigmine is an anti-cholinergic used for what?
Myasthenia gravis, paralytic ileus, and post-operative urinary retention.
What can be used to manage extrapyramidal SEs associated with antipsychotics?
Procyclidine (anti-cholinergic).
What is given in the case of a benzodiazepine OD?
Flumazenil.
What is given to reverse the effects of an opioid OD?
Naloxone
When you switch oral morphine to a SC syringe driver how do change the dose?
Half oral dose = SC driver dose
Why do opioids increase the risk of an anal fistula?
Cause constipation which leads to straining which can cause a fistula to form.
How much opioid do you prescribe for breakthrough pain?
1/6 daily dose
Chloroquine is used for malarial prophylaxis, who is it CI in? What can be given instead?
Epileptics, pts with long QT syndrome, and diabetics (can cause severe hypos).
Proguanil.
What is Artesunate used to treat?
Acute severe falciform malaria
How long after paracetamol OD should a blood sample be sent to check level? What is given in the mean time if dose is unknown?
4 hours.
IV NAC.
What are the known SEs of NSAIDs?
kidney toxicity, gastric ulceration/perforation, bronchospasm, HeTN, interruption of coagulation, urticaria.
On what substance does celecoxib act? Who is it useful for?
Cox-2 inhibitor.
Pts with have high GI bleed risk - it doesn’t target cox-1 so doesn’t affect mucosa.
Mannitol is what type of diuretic? How does it work? How is it given?
Osmotic diuretic: increases osmotic pressure in the glomeruli to increase water absorption = more excreted.
Given over slow infusion to insure water is taken from the intercellular space and not intracellular.
What type of diuretic is acetazolamide? How do these work?
Inhibit carbonic anhydrase….
reduces formation of H ions which means less are exchanged with Na in the PCT so less Na is reabsorbed (and water follows).
What are the SEs of carbonic anhydrase inhibitors?
Dizzy/lightheaded, blurred vision, loss of appetite, stomach upset.
What is acetazolamide used for?
Acute angle closure glaucoma, idiopathic intracranial HeTN, occasionally in heart failure and altitude sickness.
How do loop diuretics such as furosemide and bumetanide work? SEs?
Inhibit Na/K/Cl channel in the LoH to reduce Na reabsorption and increased excretion (water follows).
SEs- hypovolaemia, hypotension, hypokalaemia, hearing loss, raised urate.
How do thiazide diuretics work? SEs?
Block Na/Cl channel on the apical side of the DCT causing reduced Na and water reabsorption.
Hypokalaemia, hypomagnesaemia, hyponatraemia, hypercalcaemia, raised urate.
Why are thiazide diuretics limited by aldosterone?
When blood volume decreases, RAAS will act and aldosterone will increase BP.
What are the two types of K sparing diuretics?
Anti-aldosterone: spironolactone, eplerenone
Amiloride Hydrochloride: block endothelial Na channels
Why does spironolactone cause gynaecomastia?
interrupts testosterone production
What are the SEs of K sparing diuretics?
Hyperkalaemia, rash, GI upset, menstrual disorders, testicular atrophy.
Repeated doses of salbutamol can do what to potassium and lactate levels?
Hypokalaemia, raised lactate
What type of breast cancer pts is Goserelin used in? What is it? SEs?
ER +ve Premenopausal women.
GnRH analogue used to reduce oestrogen production.
Causes menopausal sx.
Tamoxifen is used in what breast cancer pts?
Oestrogen receptor +ve peri-menopausal women.
Anastrozole is is used for what type of breast cancer?
Post-menopausal ER +ve breast cancer pts.
Trastuzumab is used in which breast cancer pts? What needs monitoring?
HER2+ breast cancers.
Can be cardiotoxic so monitor cardiac function.
What is Cholestyramine?
Bile acid sequestrant: binds to bile acids to prevent them being reabsorbed.
Used for pruritis secondary to biliary pathology such as PBC.
What drugs need to be stopped in AKI?
Diuretics + Digoxin, ACEIs metformin, NSAIDs (DAMN drugs)
What is 1st line for ascites?
Spironolactone.
What drugs should be stopped in a pt with a peptic ulcer (6)?
NSAIDs, steroids, bisphosphonates, potassium supplements, SSRIs, crack cocaine
What are the main 4 receptors targeted by antiemetics? Give an example for each.
H1: Cyclizine
D2: domperidone, metoclopramide
5HT3: ondansetron
Anti-muscarinic: hyoscine hydrobromide
Where does cyclizine have an effect? Who is it CI in? SEs?
Vestibular system and chemoreceptor trigger zone and central anticholinergic effect.
CI in acute porphyria’s.
SEs dry mouth, dizziness, cardiotoxicity.
What is 1st line antiemetic for hyperemesis gravidum?
Cyclizine
Who is metoclopramide CI in? Why?
Bowel obstruction, parkinson’s, pheochromocytoma as it is prokinetic.
What is the 1st line antiemetic for Parkinson’s pts?
Domperidone
What complication can be caused by D2 receptor antagonist antiemetics? Why?
Acute dystonia/tardive dyskinesia with chronic use due to D2 receptor antagonism in the pyramidal circuits.
How do you manage oculogyric crises and cervical dystonias?
Procyclidine
Ondansetron antagonises which receptor?
5HT3 - acting on chemoreceptors in the gut.
Which antiemetic is 1st line for a post chemotherapy patient experiencing nausea but no vomiting? What dose?
Ondansetron 4-8mg
What are the SEs of ondansetron?
GI - Diarrhoea/constipation,
Consciousness - Headaches/dizziness/drowsiness.
Hyoscine hydrobromide acts on what receptor?
They are anti-muscarinic (block muscarinic receptors).
SEs of hyoscine hydrobromide?
CNS - stimulation, hallucination, seizure
Respiratory reaction,
GI upset,
Hypersensitivity reaction,
Hyperthermia,
Hypohidrosis,
Mydriasis,
Oedema,
What is 1st line for a pt taking an opioid struggling with constipation?
Stimulant laxative such as senna: up to 30mg TD
How does lactulose work? What is it used for?
Reduces ammonia production by bacteria in the gut and therefore reduces absorbability of the gut.
Used for constipation and hepatic encephalopathy.
What class of medication is doxazosin? What is it used for?
Alpha blocker used for acute urinary retention due to BPH
What is first line medication for stress incontinence?
Duloxetine
Who are alpha blockers CI in? What can be used for BPH instead?
Postural HoTN - use finasteride instead (5- alpha-reductase inhibitor).
What is 1st line for urge incontinence? Who is it CI in? What can be used instead.
Oxybutynin.
CI in frail/elderly pts due to anticholinergic SEs,
Use Mirabegron instead in these pts.
Chlorphenamine antagonises which receptor? SEs?
H1 antagonist used as an antihistamines.
Sedaive effects mosgt common.
Does have anticholinergic properties so can causes confusion, GI sx, visual disturbance, etc
What is used to manage the pruritis associated with cholestasis of pregnancy?
Chlorphenamine.
Can chlorpheniramine cross the blood/brain barrier?
Yes
What is promethazine? Who might it be avoided in?
Antihistamine with sedative and antiemetic effects.
Avoid in elderly due to sedative effects.
MOA of Carbimazole? SEs?
Inhibits thyroid peroxidase to reduce thyroid production in Grave’s disease.
SEs- rash, pruritis, agranulocytosis, neutropenia,
What drugs interact with levothyroxine (4)?
Ferrous sulphate, calcium chloride, digoxin, HRT
What is first line for cluster headaches? (Acute and prophylaxis)
Acute- 100% O2, Nasal sumatriptan
Prophylaxis- verapamil or topiramate
What is used for migraine prophylaxis in asthmatic pts?
Topiramate or amitriptyline
What SEs is topiramate associated with?
Weight loss, renal stones, and cognitive/behavioural changes.
Who are Triptans CI in when treating migraine?
HeTN, PVD, stroke, TIA, ischaemic heart disease (including angina).
What type of acidosis can topiramate cause?
Mixed type 1 and 2 renal tubular acidosis (presents with non specific sx)
What is 1st line for peripheral neuropathy?
Tricyclic antidepressant such as amitriptyline.
What is 1st line for diabetic neuropthy?
Anti-depressants such as Duloxetine, anti-epileptics such as gabapentin, or pregabalin can also be considered.
What two medications are used for medical abortion?
1) Mifepristone (induce miscarriage)
2) Misoprostol (expulsion of foetal tissue)
What can be used for restlessness in EOL care?
Haloperidol
What is used to manage secretions which cause ‘the ‘death rattle’ in EOL care?
- Glycopyrronium bromide
- Hyoscine hydrobromide
- Hyoscine butyl bromide (buscapan)
What is used for pain management and breathlessness in EOL care?
Morphine
Which antiemetic medications are used for EOL care?
Cyclizine, levomepromazine
What is used for anxiety and dyspnoea in EOL care?
Benzodiazepines
What can be used in pts taking high doses of opioids in EOL, who are facing significant constipation?
Bowel-specific opioid antagonists (relistor).
What is the MOA of bisphosphonates such as Risedronate? SEs?
inhibit osteoclastic activity meaning less bone breakdown = reduced fracture risk.
SEs- dyspepsia/reflux so often given alongside PPI, can get necrosis of the jaw (should have dentist check before starting).
What is the MOA of fomepizole?
Inhibits alcohol dehydrogenase to treat ethylene glycol (anti-freeze) or methanol poisoning.
Acamprosate is used for what?
Used to reduce cravings during recovery from alcohol dependence.
What happens when sildenafil an GTN interact?
Drop in BP - significant raise in cGMP levels cause vasodilation and profound HoTN.
What happens when loop diuretics and digoxin interact?
Precipitates hypokalaemia leading to digoxin toxicity (visual discolouration, dizziness, syncope, palpitations, dyspnoea)
What happens when trimethoprim and methotrexate interact?
Bone marrow suppression
What are the common cytochrome P450 inhibitors?
O DEVICES:
- omeprazole
- disulfiram
- erythromycin and other macrolides
- valproate
- isoniazid
- ciprofloxacin
- ethanol
- sulphonamides
What happens when statins interact with macrolides?
rhabdomyolysis
What happens when allopurinol and azathioprine interact?
bone marrow dyscrasias and neutropenic sepsis
What happens when methadone and ondansetron interact?
QT prolongation
Why does ciprofloxacin increase INR in warfarin pts?
Cipro is a p450 inhibitor therefore increases warfarin levels as less in broken down/excreted.
Which asthma medications can cause nightmares, especially in the paediatric pts?
Montelukast
Short term use of levodopa can cause which of of the following:
- Morning hypokinesia
- Dyskinesia
- Abnormal Dreams
Abnormal dreams
How can you manage a beta blocker OD?
Atropine to treat bradycardia and hypotension, if this fails give glucagon (improve heart rate and myocardial contractility).
Someone with G6PD presenting with a UTI is CI to what antibiotic? What would you give them instead?
CI to nitrofurantoin.
Give trimethoprim (unless this is CI, in which case give pivmecillinam).
Why might someone on carbamazepine have a low sodium?
It can trigger SIADH which causes a euvolemic hyponatraemia with a low plasma osmolality and high urine osmolality.
What is the MOA of allopruinol?
Xanthine oxidase inhibitor, by blocking this it reduces production of purines thereby reducing uric acid production.
What level of lithium toxicity requires haemodialysis?
> 4 or >2.5 with kidney dysfunction
Which antihypertensive is known to cause gum hypertrophy and pain?
Amlodipine
What type of kidney disease is caused by PPIs such as omeprazole?
Acute interstitial nephritis.
What is the role of mebeverine in IBS?
Antispasmodic used to control sx.
Which PPI is know to reduce the efficacy of clopidogrel? Which do you use instead?
Omeprazole.
Swap for lansoprazole when prescribing clopidogrel.
What is 1st line for treating features of psychosis and hallucinations in Parkinson’s pts?
Quetiapine
What is the 1st line medication for helping smoking cessation? What serious SE is it associated with it?
Varenicline
Can cause mood changes and suicidal ideation.
When should someone skip their contraceptive pill-fee interval after having missed day(s) of their contraceptive pill?
If the pills that were missed were in week 3 (15-21days).
What Topiramate used for? What are the SEs?
- Epilepsy: generalised tonic-clonic and focal seizures.
- Migraine prophylaxis.
SEs: weight loss, renal stones, cognitive and behavioural changes.
Long term use of antipsychotics increases risk of what vascular event? Why?
Stroke - increased lipid levels and weight gain.
What type of drug is Infliximab?
Anti-TNF
What can be used for worsening dysphagia in a palliative oesophageal carcinoma?
Dexamethasone 8 mg (soluble tablets)
Sertraline is an SSRI associated with kind of sexual dysfunction?
Erectile dysfunction and reduced libido
What is the management of an anaphylactoid reaction to IV NAC?
Stop transfusion, give 10 mg IV chlorphenamine, restart transfusion when sx have settled.
What is the cut off ambulatory BP for commencing antihypertensives?
> 140/90
How do you manage someone with a QRISK >10%?
1) lifestyle changes and retest 6-12 months later
2) STATINS in lifestyle changes ineffective
