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MRCP Revision > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Phase I reactions

A

oxidation, reduction, hydrolysis, by P450 enzymes or specific enzymes

Products generally more active, potentially toxic,

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2
Q

Phase II reactions

A

conjugation, gucuronyl, acetyl, methyl, sulfate groups

Products typically inactive, excreted in urine/bile

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3
Q

drugs undergoing significant 1st pass metabolism

A

(Love at first sight - heart related meds)

aspirin
isosorbide dinitrate
GTN
lignoicaine
propranolol
verapamil
isoprenaline

then you have steroids and testosterone

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4
Q

Drugs with zero order kinetics

A

(When you lose the girl)
ethanol
MI (aspirin, heparin)
seizures (phenytoin)

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5
Q

Drugs dependent on acetylator status

A

(HIgh SPeeD) Hydralazine, Isoniazid, Sulfasalazine, Procainamide, Dapsone.

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6
Q

CYP 450 inducers

A

CRAPGPS carbamazepine, rifampicin, alcohol (chronic), phenytoin, griseofulvin, phenobarbitone, sulphonylureas/smoking/St John’s wort

Nevirapine as well

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7
Q

CYP450 inhibitors

A

SICKFACES.COM sodium valproate, isoniazid, cimetidine, ketoconazole/fluconazole, fluoxetine/sertraline, alcohol (acute)/allopurinol/amiodarone, ciprofloxacin/chloramphenicol, erythromycin/clarithromycin, sulphonamides, cardiac/liver failure, omeprazole, metronidazole

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8
Q

What happens in paracetamol overdose

A

depletion of glutathione stores (would usually conjugate to form non-toxic mercapturic acid), raised toxic NAPQI (from to mixed metabolisation by P450 oxidases). Toxins form covalent bonds with cell proteins, denaturing them, leading to cell dealth in liver + kidney.

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9
Q

What is a staggered paracetamol OD?

A

Staggered OD if all tablets not within 1hr

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10
Q

Initial Treatment of paracetamol OD

A

NAC (over 1hr) - precursor of glutathione → replenishes glutathione

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11
Q

Indications for transplantation in Paracetamol OD

A

Transplant if: pH<7.3 24hrs post-ingestion or all of: PT>100s + Creat>300 + Grade 3 or 4 encephalopathy

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12
Q

TCA overdose features and ECG

A

serotonin, noradrenergic, anti-cholinergic, anti-histamine effects. anticholinergic

sx: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision

Severe sx: Arrhythmias, seizures, acidosis, coma

ECG: tachy, broad complex, prolonged QT. QRS>100 associated with seizures, QRS >160 assx with arrhythmias.

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13
Q

TCA OD Rx

A

Rx: IV bicarbonate (if: pH<7.1, QRS>160, Arrhythmias, hypotension), lipid emulsion

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14
Q

What drugs are contraindicated in TCA ODs to treat arrhythmias?

A

Class 1a (quinidine), Class 1c (flecainide), Class III (amiodarone) antiarrhythmics contraindicated as they prolong depolarisation

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15
Q

Quinine toxicity/cinchonism features

A

cinchonism - hypotension, acidosis, hypoglycemia (pancreatic insulin secretion stimulated), tinnitus, flushing, visual disturbances, flash pulm oedema, dry skin, abdo pain, AKI - neuro damage permanent, difficult to distinguish from aspirin poisoning.

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16
Q

Quinine toxicity ECG features:

A

long QRS, QTc, (Na, K channels blocked)

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17
Q

Lithium toxicity is at what level, and when to take this dose?

A

> 1.5, taken 12hrs post-dose

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18
Q

Precipitants of lithium toxicity

A

AKI, dehydration, drugs causing those + metronidazole.

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19
Q

Lithium toxicity features

A

coarse tremor, hyperreflexia, confusion, polyuria, seizure, coma.

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20
Q

Treatment of lithium toxicity

A

mild-mod IVF. Severe: haemodialysis. Sometimes bicarb (increases urinary alkalisation, increases excretion)

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21
Q

Carbon monoxide poisoning oxygen dissociation curve shift

A

left shift, reduced oxygen saturation

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22
Q

Features of CO poisoning

A

headache, N&V, vertigo, confusion, weakness, pink skin/mucosa, hyperpyrexia, arrhythmias, extrapyramidal sx, coma.

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23
Q

Rx for CO poisoning

A

100% high flow oxygen min 6hrs

hyperbaric oxygen (indicated if levels>25%, LOC, neuro sx other than headache, MI, arrhythmia, pregnancy)

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24
Q

Cyanide poisoning mechanism

A

inhibits cytochrome c oxidase → cessation of mitochondrial electron transfer chain.

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25
Q

Cyanide poisoning features

A

brick-red skin, bitter almond smell, hypoxia, hypotension, headache, confusion.

Later, ataxia, peripheral neuropathy, dermatitis.

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26
Q

Rx for cyanide poisoning

A

100% oxygen, hydroxocobalamin IV, inhaled amyl nitrite, IV sodium nitrite, IV sodium thiosulfate

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27
Q

Ecstasy poisoning features

A

neuro (agitation, anxiety, confusion, ataxia), cardio (tachy, HTN), hypoNa (SIADH or excessive water), hyperthermia, rhabdomyolysis.

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28
Q

Rx for ecstasy poisoning

A

supportive, dantrolene for hyperthermia if supportive fails

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29
Q

Cocaine OD features

A

blocks dopamine, noradrenaline, serotonin uptake.

CVS: coronary spasm, tachy/bradycardias, HTN, QRS widening, long QT, dissection.

Neuro/psych: seizures, mydriasis, hypertonia, hyperreflexia, agitation, psychosis, hallucinations.

Others: ischaemic colitis, hyperthermia, acidosis, rhabdomyolysis

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30
Q

Rx for cocaine OD

A

benzos

HTN: + nitroprusside
ACS: + GTN + PCI

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31
Q

Salicylate OD features

A

metabolic acidosis + resp alkalosis. Sx: hyperventilation (central stimulation), tinnitus, lethargy, sweating, pyrexia, N&V, hyperglycaemia/hypoglycaemia, seizures, coma.

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32
Q

Rx for salicylate OD

A

urinary alkalisation with IV bicarbonate, haemodialysis (indications: conc>700, acidosis resistant to treatment, AKI, pulmonary oedema, seizures, coma)

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33
Q

Ethylene Glycol toxicity features

A

Stage 1: like ETOH intoxication
Stage 2: metabolic acidosis, high anion gap, high osmolar gap, tachycardia, HTN
Stage 3: AKI.

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34
Q

Ethylene Glycol toxicity Rx:

A

fomepizole (inhibits ETOH dehydrogenase, prevents build up of toxic metaolite), ETOH competes fo ETOH dehydrogenase, haemodialysis

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35
Q

Methanol poisoning features

A

Sx: like ETOH intoxication + visual problems, due to formic acid buildup.

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36
Q

Rx for methanol poisoning

A

fomepizole or ethanol, haemodialysis, cofactor therapy with folinic acid

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37
Q

Organophosphate poisoning

A

DUMBELLS diarrhoea, urination, miosis/muscle weakness, bronchorrhoea/bradycardia, emesis, lacrimation, salivation/sweating.

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38
Q

Rx for organophosphate poisoning

A

atropine

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39
Q

Mercury poisoning common cause

A

lots of tuna

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40
Q

Mercury poisoning mechanism

A

Irreversible inhibition of selenoenzymes

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41
Q

Features of mercury poisoning

A

paraesthesia, visual field defects, hearing loss, irritability, RTAs. (If you can’t see or hear in an RTA, your senses get weird and you get irritable)

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42
Q

Local anaesthetic toxicity features

A

CNS over-activity then depression (initially blocks inhibitory pathways then blocks both inhibitory and activating), with arrhythmias.

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43
Q

Lidocaine interactions with drugs

A

beta blockers, ciprofloxacin, phenytoin.

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44
Q

Rx for lidocaine/local anaesthetic toxicity

A

Lipid emulsion

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45
Q

Management for caustic substance ingestion

A

urgent upper GI surgical referral if perforation. Do not neutralise. High dose IV PPI.

Upper GI endoscopy if symptomatic.

Asymptomatic - discharge after oral fluid trial + observation.

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46
Q

Complications of caustic substance ingestion

A

ulceration, perforation, airway injury/compromise, aspiration, infection, electrolytes (eg hypoCa in hydrofluoric acid ingestion)

Chronic; strictures, fistulae, gastric outlet obstruction, upper GI Ca (1000-3000x risk)

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47
Q

Side effect of erythropoietin

A

pure red cell aplasia

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48
Q

Rifampicin SEs:

A

hepatitis, orange secretions, flu-like sx, CYP450 inducer

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49
Q

Isoniazid MoA:

A

inhibits mycolic acid synthesis

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50
Q

Isoniazid SEs:

A

peripheral neuropathy (give pyridoxine vit b6), hepatitis, agranulocytosis, liver enzyme inhibitor

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51
Q

Pyrazinamide MoA:

A

converted by pyrazinamidase to pyrazinoic acid which inhibits fatty acid synthase (FAS) I.

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52
Q

Pyrazinamide SEs:

A

arthralgia, myalgia, hepatitis

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53
Q

Ethambutol MoAs

A

nhibits arabiosyl transferase which polymerises arabinose to arabian.

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54
Q

Ethambutol SEs:

A

optic neuritis (check visual acuity before and during treatment), renally excreted - dose needs adjusting with renal impairment

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55
Q

ODs that can be treated with haemodialysis

A

BLAST barbiturates, lithium, alcohol (including methanol), salicylates, theophylline (charcoal haemoperfusion preferred)

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56
Q

Serotonin syndrome features:

A

neuromuscular excitation (hyperreflexia, myoclonus, rigidity)
autonomic nervous system excitation
(hyperthermia, sweating)
altered mental state
confusion

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57
Q

Serotonin syndrome Rx:

A

IVF
Benzos
Cyproheptadine

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58
Q

Drugs causing thrombocytopenia

A

HANDQ - heparin, AEDs (carbamazepine, valproate, Abx (penicillins, sulphonamides, rifamipicin), Abciximab, NSAIDs, diuretics, Quinine.

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59
Q

Ciclosporin MoA

A

Reduces IL2 release, forms complex with cyclophilin, inhibits calcineurin, reduces T cell proliferation.

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60
Q

Indications for ciclosporin

A

Organ transplant, Rh Arth, psoriasis, UC, pure red cell aplasia.

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61
Q

Is ciclosporin myelotoxic?

A

No

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62
Q

ciclosporin SEs:

A

renal, liver, everything increased/hyper (fluid, bp, K, hair, gums, glucose, lipids), tremor, infection.

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63
Q

When to check ciclosporin level

A

immediately before dose

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64
Q

Tacrolimus MoA

A

reduces IL2 release, binds to FKBP, complex inhibits calcineurin

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65
Q

Compare ciclosporin vs tacrolimus

A

Tacrolimus more potent, more nephrotoxic, results in more impaired glucose tolerance

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66
Q

Gynaecomastia drugs

A

DISCO (digoxin, isoniazid, spironolactone, cimetidine, oestrogen), finasteride

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67
Q

gingival hyperplasia causes

A

PACC phenytoin, AML, ciclosporin, CCBs.

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68
Q

Hydralazine MoA

A

elevates cGMP, smooth muscle relaxation in arterioles.

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69
Q

Hydralazine contraindications

A

SLE, IHD, CVA.

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70
Q

Indication for Hydralazine in HF

A

Afro-Caribbeans
Only to be given with nitrates

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71
Q

Ivabradine MoA

A

Inhibits funny channels

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72
Q

Indication for Ivabradine in HF

A

LVEF<35%
sinus, rate >75bpm (blocks cardiac pacing channels so contraindicated for lower resting HRs)

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73
Q

List some centrally acting anti-HTN meds

A

methyldopa, moxonidine, clonidine (alpha 2 agonism in vasomotor centre)

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74
Q

MoA for bivalirudin

A

direct thrombin inhibitor

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75
Q

Adenosine MoA

A

A1 agnoism at AV node, inhibits adenylyl cyclase, reduces cAMP, increases K efflux

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76
Q

Half-life of adenosine

A

8-10s

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77
Q

Interactions with adenosine (the 2 important ones)

A

DEAR:
dipyridamole enhances action
aminophylline reduces action

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78
Q

Nicorandil MoA

A

guanylyl cyclase activation, cGMP increase

Acts both as nitrate and non-selective ATP-sensitive K channel activator (in smooth muscles) → hyperpolarisation, relaxation→ increased blood flow to myocardium + reduction of workload

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79
Q

Nicorandil SEs:

A

headache, flushing, anal/GI ulcerations.

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80
Q

Nicorandil contraindication

A

LVF

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81
Q

Dipyridamole MoA

A

non-specific phosphodiesterase inhibitor, antiplatelet (given post CVA/TIA if clopidogrel not tolerated)

Elevates cAMP, reduces intracellular Ca. reduces adenosine uptake, inhibits thromboxane synthase

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82
Q

Aspirin MoA

A

irreversible COX1,2 inhibitor. Thromboxane A2 blocked → reduced pltlt aggregation.

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83
Q

Interactions with aspirin

A

oral hypoglycaemics, warfarin, steroids potentiate action

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84
Q

Clopidogrel MoA

A

P2Y12 inhibitor, irreversible Adenosine diphosphate receptor antagonist on platelets.

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85
Q

Clopidogrel and PPIs

A

Less effective with it but lansoprazole ok

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86
Q

Ticagrelor MoA

A

inhibits adenosine deaminase, inhibits adenosine clearance, causes dyspnoea

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87
Q

Tirofiban MoA

A

anti-GIIb/IIIa → prevents fibrinogen binding → blocks pltlt aggreg (others of same class: abciximab, eptifibatide)

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88
Q

Thiazides SE:

A

hypoK, Na, hyperCa/hypercalciuria, postural hypotension, gout, impotence, impaired glucose tolerance, thrombocytopenia, agranulocytosis, pancreatitis, photosensitivity rash

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89
Q

Furosemide SE

A

hypoNa, Mg, Ca, hypochloraemic alkalosis, ototoxicity, gout, AKI, low bp, hyperglycaemia

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90
Q

K sparing diuretics types

A

Epithelial sodium channel blockers: amiloride (in DCT), triamterene

Aldosterone antagonists: spironolactone, eplerenone

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91
Q

Naftidrofuryl MoA

A

5HT2 antagonist for PAD, vasodilator

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92
Q

Cilostazol MoA

A

PDE III inhibitor - vasodilator, antiplatelet, for PAD

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93
Q

Vaughan Williams classification

A

1: Na channel
2: beta blockers
3: K channel
4: Ca channel

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94
Q

Class Ia anti-arrhythmics

A

increases AP duration: Quinidine/procainamide/disopyramide. SE: quinidine- cinchonism (headache, tinnitus, thrombocytopenia), procainamide- drug-induced lupus

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95
Q

Class Ib anti-arrhythmics

A

reduces AP duration: lidocaine/mexiletine/tocainide

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96
Q

class Ic anti-arrhythmics

A

no AP change: encainide, propafenone

97
Q

Flecainide MoA

A

Nav1.5 Na channel

98
Q

Flecainide contraindications

A

post-MI, HF, sinus node dysfunction/AV block, a flutter.

99
Q

Flecainide SE:

A

negatively inotropic, bradycardia, proarrhythmic (widened QRS, prolonged PR, oral paraesthesia, visual disturbance)

100
Q

Beta blocker SEs:

A

bronchospasm, fatigue, cold periph, sleep dist

101
Q

Examples of class III anti-arrhythmics

A

amiodarone, sotalol, ibutilide, bretylium

102
Q

amiodarone half-life

A

20-100 days

103
Q

What to monitor and when for amiodarone

A

TFTs, LFTs, U&Es, CXR pre-Rx then TFT, LFT every 6 months

104
Q

Amiodarone SEs:

A

thyroid, corneal deposits, lungs, liver, periph neuropathy, photosensitivity, slate grey appearance, bradycardia, long QTc, thrombophlebitis

Amiodarone induced hypothyroidism: Wolff-Chaikoff effect. Rx: can continue + give thyroxine

Amiodarone induced thyrotoxicosis:
Type 1: excess iodine-induced thyroid hormone synthesis, goitre present. Rx: carbimazole or potassium perchlorate
Type 2: destructive thyroiditis. Rx: steroids

105
Q

Verapamil SEs/cautions

A

avoid in VT, HF, constipation, hypotension, bradycardia, flushing

106
Q

Diltiazem SE/Cautions

A

hypotension, bradycardia, HF, ankle swelling

107
Q

Nifedipine/amlodipine/felodipine SEs:

A

(dihydropyridine - not an anti-arrhythmic): SE: flushing, headache, ankle swelling

108
Q

Digoxin MoA

A

inhibition of Na/K ATP-ase pump, stimulates vagus, blocks AV node

109
Q

When to measure digoxin levels

A

when toxicity suspected,
within 8-12 hrs of last dose

110
Q

ECG features with digoxin toxicity

A

down-sloping ST depression (reverse tick), flattened T, shortened QT, AV block/bradycardia.

111
Q

Risk factors for digoxin toxicity

A

hypoK, hypoMg, hyperCa, hyperNa, acidosis, hypothermia, hypothyroid, increasing age, renal failure, MI, amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for DCT secretion), ciclosporin, thiazides, furosemide. Rx: digibind, correct arrhythmias, monitor potassium

112
Q

Features of digoxin toxicity

A

lethargy, N&V, anorexia, confusion, yellow-green vision, brady-arrhythmias, gynaecomastia.

113
Q

alpha 1 agonists

A

phenylephrine (vasoconstriction, GI sm relaxation, salivary secretion, hepatic glycogenolysis). Activates phospholipase C → IP3 → DAG

114
Q

Alpha 2 agonist

A

clonidine (presynaptic inhibition, inhibits insulin, pltlt aggregation). Inhibits adenylate cyclase

115
Q

Beta 1 agonist

A

dobutamine (ionotropic + chronotropic). Stimulates adenylate cyclase

116
Q

Beta 2 agonists

A

salbutamol (bronchodilation, vasodilation, GI sm relaxation). Stimulates adenylate cyclase

117
Q

Beta 3 agonist

A

(lipolysis). Stimulates adenylate cyclase

118
Q

Adrenaline actions:

A

induces hyperglycaemia, hyperlactataemia, hypokalaemia, low insulin.

Alpha agonist: inhibits pancreatic insulin secretion, stimulates hepatic and muscular glycogenolysis, stimulates muscular glycolysis.

Beta agonist: stimulates pancreatic glucagon secretion, stimulates ACTH, stimulates lipolysis

119
Q

Accidntal adrenaline injection Rx:

A

local infiltration of phentolamine (alpha 1+ 2 blocker)

120
Q

Alpha 1 antagonist

A

doxazosin
Alpha1a: tamsulosin

121
Q

Alpha 2 antagonist

A

yohimbine

122
Q

Alpha non-selective antagonist

A

phenoxybenzamine,
phentolamine

123
Q

beta 1 antagoist

A

atenololb

124
Q

beta non-selective antagonist

A

propanolol

125
Q

mixed alpha beta blocker

A

carvedilol, labetalol

126
Q

What is a hybridoma

A

fusion of myeloma cells + mouse splenic cells

127
Q

What is ‘humanising’ in making mAbs?

A

Humanising involves combining variable mouse region with human constant region

128
Q

Infliximab MoA and uses

A

anti-TNFa
RhArth, Crohns

129
Q

Rituximab MoA and uses

A

anti-CD20, non-Hodkin’s, Rh Arthr

130
Q

Cetuximab MoA and uses

A

EGFR, met colorectal Ca, head and neck

131
Q

Erlotinib MoA and uses

A

EGFR, lung Ca

132
Q

Trastuzumab MoA and uses

A

(herceptin) Her2/neu receptor, met breast Ca.

133
Q

Trastuzumab caution before use

A

Must do Echo before due to cardiotoxicity (more common when anthracyclines also used)

134
Q

Alemtuzumab MoA and use

A

anti-CD52, CLL

135
Q

Abciximab MoA and use

A

GpIIb/IIIa, IHD for PCI

136
Q

OKT3 MoA and use

A

anti-CD3 organ rejection

137
Q

Nivolumab MoA and use

A

anti-PD1, met melanoma, lymphoma (used with ipilimumab)

138
Q

Bevacizumab MoA and use

A

VEGF, colorectal Ca

139
Q

Crizotinib MoA and use

A

ALK-1, NSCLC

140
Q

Ipilimumab MoA

A

CTLA-4

141
Q

Drugs causing urticaria

A

NAPPi - NSAIDs, aspirin, penicillins, oPiates

142
Q

Heparin MoA

A

activates antithrombin III.

unfractionated: complex inhibits thrombin, factors 9a, 10a, 11a, 12a.

LMWH: complex inhibits 10a,

143
Q

Heparin SEs:

A

bleeding, thrombocytopenia (heparin-induced thrombocytopenia: abs vs PF4 + heparin, develops after 5-10 days, actually prothrombotic, may need ongoing anticoagulation with direct thrombin inhibitor/danaparoid), osteoporosis, hyperkalaemia (inhibits aldosterone secretion)

LMWF has lower risk of HIT

144
Q

Penicillin, cephalosporins, carbopenems MoA

A

inhibits peptidoglycan cross-linking, inhibiting cell wall formation

145
Q

Glycopeptide MoA

A

inhibits peptidoglycan synthesis

146
Q

Ribosomal 30S subunit inhibitors

A

aminoglycosides, tetracyclines

147
Q

Ribosomal 50S subunit inhibitors

A

Macrolides, chloramphenicol, clindamycin, linezolid, streptogrammins

148
Q

Gentamicin SE:

A

ototoxicity, nephrotoxicity (ATN).

149
Q

Gentamicin contraindication

A

myasthenia

150
Q

Monitoring of gentamicin

A

Peak + trouh levels

151
Q

Quinolone MoA

A

Inhibits topoisomerase II (DNA gyrase) and IV

152
Q

Mechanism of resistance to Quinolones

A

mutations to DNA gyrase, efflux pumps

153
Q

Quinolones SE:

A

lowers seizure threshold, tendon damage (increased with steroids), cartilage damage, long QTc.

154
Q

Quinolones contraindications

A

pregnancy/breastfeeding
G6PD deficiency

155
Q

Metronidazole MoA

A

damages DNA

156
Q

Sulphonamides, trimethoprim MoA

A

inhibits folic acid formation

157
Q

Rifampicin MoA

A

inhibits RNA synthesis

158
Q

ACE inhibitor teratogenecity

A

renal dysgenesis, craniofacial abnormalities

159
Q

ETOH teratogenecity

A

craniofacial abnormalities

160
Q

Aminoglycoside teratogenecity

A

ototoxicity

161
Q

Carbamazepine teratogenecity

A

NTD, craniofacial abn

162
Q

Chloramphenicol teratogenecity

A

grey baby syndrome

163
Q

Cocaine teratogenecity

A

IUGR, preterm labour

164
Q

Diethylstillbesterol teratogenecity

A

vaginal clear cell adenocarcinoma

165
Q

Lithium teratogenecity

A

Ebstein’s anomaly

166
Q

Maternal DM teratogenecity

A

Macrosomia, NTDs, polyhydramnios, preterm labour, caudal regression syndrome

167
Q

Smoking teratogenecity

A

Preterm labour, IUGR

168
Q

Tetracyclines teratogenecity

A

Discoloured teeth

169
Q

Thalidomide teratogenecity

A

Limb reduction defects

170
Q

Valproate teratogenecity

A

NTD, craniofacial abnormalities

171
Q

Warfarin teratogenecity

A

craniofacial abnormalities

172
Q

Motion sickness Rx

A

Hyoscine patch> cyclizine/cinnarizine (non-sedating anti histamines)>promethazine

173
Q

Oculogyric crisis features

A

restlessness, agitation, upward deviation eyes

174
Q

Causes of oculogyric crisis

A

antipsychotics, metoclopramide, post-encephalitic PD

175
Q

Rx of oculogyric crisis

A

benztropine, procyclidine

176
Q

Allopurinol. How to use for gout

A

100mg OD initial dose for gout, to titrate every few wks for serum uric acid <300, with colchicine cover to be considered.

177
Q

SE of allopurinol

A

derm (severe cutaneous adverse reaction, DRESS, Stevens-Johnson syndrome, East Asians more at risk - HLA-B*5801 screening for high cutaneous risk).

178
Q

HLA type spcific for risk of severe cutaneous reaction to allopurinol

A

HLA-B*5801 in East Asians

179
Q

Allopurinol interactions

A

azathioprine (as xanthine oxidase oxidises 6-mercaptopurine to 6-thiouric acid), cyclophosphamide (allopurinol reduces renal clearance), theophylline (inhibits breakdown)

180
Q

DRESS causes

A

Causes: allopurinol, AEDs, Abx, immunosuppressants, HIV Rx, NSAIDs.

181
Q

DRESS Dx

A

3 of: hospitalisation, reaction suspected, acute skin rash, fever, lymphadenopathy at least 2 sites, at least 1 internal organ involved, blood abnormalities. Skin biopsy: inflammatory infiltrate

182
Q

Skin manifestations of DRESS

A

morbilliform rash 80%, exfoliative dermatitis with high fever, vesicles, bullae, erythroderma 10%, mucosal involvement 25%, facial swelling 30%, 2-8wks after starting offending drug

183
Q

Bloods in DRESS

A

raised/low WCC, eosinophilia 30%>2.0, thrombocytopaenia, anaemia, atypical lymphocyte. Lymphadenopathy 75%

184
Q

Liver in DRESS

A

hepatomegaly, hepatitis, rarely hepatic necrosis

185
Q

Lungs in DRESS

A

pneumonitis, pleuritis, pneumonia

186
Q

Kidney in DRESS

A

10% usually mild kidney disease (interstitial nephritis common)

187
Q

Heart in DRESS

A

Myocarditis, pericarditis

188
Q

Neuro in DRESS

A

meningitis, encephalitis

189
Q

GI in DRESS

A

upset, acute colitis, pancreatitis

190
Q

Endocrine in DRESS

A

thyroiditis, diabetes

191
Q

Statins SE:

A

myopathy (simvastatin, atorvastatin>rosuvastatin, pravastatin, fluvastatin), liver impairment

192
Q

Statin monitoring

A

LFTs at baseline, 3 months, 12 months, stop statin if >3x ULN

193
Q

Statin contraindication:

A

macrolides
pregnancy

194
Q

Ezetimibe MoA

A

reduces small intestinal cholesterol absorption.

195
Q

Ezetimibe SE:

A

headache

196
Q

Nicotinic acid MOA

A

reduces hepatic VLDL secretion.

197
Q

Nitotinic acid SE

A

flushing
myositis

198
Q

Fibrates MOA

A

PPAR-alpha agonist, increases lipoprotein lipase expression.

199
Q

Fibrates SE

A

myositis
pruritis
cholestasis
VTE

200
Q

Cholestyramine MOA

A

reduces small intestine bile acid reabsorption, upregulates cholesterol converted to bile acid.

201
Q

Cholestyramine SE

A

GI upset, cholesterol gallstones, may raise triglyceride levels, reduces absorption of fat soluble vitamins

202
Q

Hypomagnesaemia causes

A

PPIs, diuretics, TPN, ETOH, diarrhoea (magnesium can also result in diarrhoea when given orally), hypoK, hyperCa (Ca and Mg compete in thick ascending Loop of Henle), Gitelman’s, Bartter’s.

203
Q

HypoMg features

A

similar to hypoCa. ECG: similar to hypoK. Exacerbates digoxin tox.

204
Q

Causes of agranulocytosis (Drugs)

A

thyroid drugs (carbimazole, propylthiouracil) atypical antipsychotics (clozapine), AEDs (carbamazepine), Abx (penicillin, chloramphenicol, co-trim), mirtazapine, methotrexate

205
Q

Drug causes of photosensitivity

A

TANS in Pic Thiazides, tetracyclines, amiodarone, NSAIDs, sulphonamides, psoralens, ciprofloxacin

206
Q

Drug-induced impaired glucose tolerance

A

TASTIN thiazides, antipsychotics, steroids, tacrolimus/ciclosporin, IFN alpha, nicotinic acid. Beta blockers slight

207
Q

Dopamine receptor agonists examples

A

ropinirole, apomorphine. Bromocriptine, cabergoline (ergot-derived)

208
Q

Dopamine receptor agonist SE:

A

(ergot-derived) SE: pulmonary, retroperitoneal, cardiac fibrosis (requires ESR, creatinine, CXR).

General SE: N&V, postural hypotension, hallucinations, daytime somnolence

209
Q

octreotide MoA

A

long-actin somatostatin analogue, inhibits GH, glucagon, insulin.

210
Q

Octreotide SE:

A

gallstones (2 to biliary stasis)

211
Q

COCP precaution with abx

A

none except with rifampicin/rifaximin

212
Q

Muscarinic agonists

A

Pilocarpine: glaucoma, M1-3 receptors, contraction of ciliary body in eye relieving pressure, miosis. Also induces salivation

213
Q

Muscarinic antagonists

A

atropine, ipratropium/tiotropium, oxybutynin

214
Q

Nicotinic agonist examples

A

nicotine, vaerenicicline, suxamethonium

215
Q

Nicotinic antagonist examples

A

Atracurium, Vecuronium, pancuronium

216
Q

Suxamethonium MOA and uses

A

depolarising muscle relaxant. Inhibits ACh at NMJ, degraded by acetylcholinesterase and cholinesterase.

Fastest onset, shortest duration of action of all muscle relaxants (best for Rapid Sequence Induction). Produces generalised muscular contraction pre-paralysis.

217
Q

Suxamethonium SE

A

hyperK, malignant hyperthermia, lack of acetylcholinesterase

218
Q

Atracurium MoA, metabolism

A

Non-depolarising muscle relaxant. Nicotinic antagonist. Duration of action 30-45mins.

Metabolism: hydrolysis (non-hepatic/renal excretion). Reversed by neostigmine.

219
Q

Atracurium SE

A

facial flushing, tachycardia, hypotension due to generalised histamine release on administration.

220
Q

Vecuronium action, metabolism

A

non-depolarising. Duration of action 30-40 mins. Hepatic + Renal metabolism, effects prolonged in organ dysfunction. Reversed by neostigmine

221
Q

Pancuronium action, metabolism

A

onset 2-3 minutes, duration of action 2 hrs. Reversed with neostigmine.

222
Q

Drugs causing cataracts

A

steroids

223
Q

Drugs causing corneal opacities

A

amiodarone
indomethacin

224
Q

drugs causing optic neuritis

A

ethambutol
amiodarone
metronidazole

225
Q

Drugs causing retinopathy

A

chloroquine, quinine

226
Q

Sildenafil SE

A

blue discolouration, non-arteritic anterior ischaemic neuropathy, nasal congestion, flushing, GI upset, headache, priapism

227
Q

Sildenafil contraindication

A

nitrates/nicorandil, hypotension, recent CVA/MI

228
Q

Drug causing lung fibrosis

A

CRANE cytotoxics (bleomycin, busulphan), anti-Rheumatoid (methotrexate, sulfasalazine), amiodarone, nitrofurantoin, ergot-derived dopaminergics (bromocriptine, cabergoline, pergolide)

229
Q

Drugs causing urinary retention

A

NO TAD NSAIDS, Opioids, TCAs, Anticholinergics, Dispyramide.

230
Q

Drugs contraindicated in pregnancy

A

Abx: tetracyclines, aminoglycosides, sulphonamides (trimethoprim), quinolones
ACEi, ARBs, statins, warfarin, sulfonylureas, retinoids, cytotoxic agents
AEDs are potentially harmful

231
Q

Drugs contraindicated in breastfeeding

A

cipro, doxy, chloramphenicol, sulphonamides, lithium, benzos, aspirin, carbimazole, methotrexate, sulfonylureas, cytotoxics, amiodarone, high dose steroids

232
Q

Advantages vs disadvantages of progesterone only pill

A

Advantages: effective, no sex issues, reversible on stopping, can use with breastfeeding, can be used in smokers>35yrs, in women with VTE hx

Disadvantages: irregular periods (most common), functional ovarian cysts, weight gain, breast tenderness, acne, headaches (goes away after first few months)

233
Q

Contraindications in COCP

A

UKMEC4: age>35yrs + 15cigs/day, migraine with aura, VTE/IHD/CVA hx, breast feeding <6wks post-partum, uncontrolled HTN, current breast Ca, major surgery with prolonged immobilisation, antiphospholipid abs

UKMEC3: >35yrs less than 15 cigs/day, BMI>35, VTE fhx 1st deg relatives <45yrs, uncontrolled HTN, immobility, BRCA1/2/breast Ca gene mutation, current GB disease

234
Q

Propofol

A

GABA agonist, rapid onset, anti-emetic, moderate myocardial depression, little metabolite accumulation

235
Q

Sodium thiopentone

A

rapid onset, marked myocardial depression, quick build-up of metabolites, not for maintenance infusion, little analgesic

236
Q

Ketamine

A

NMDA antagonist, induction of anaesthesia, moderate-strong analgesic, little myocardial depression, may induce dissociative anaesthesia state with nightmares

237
Q

Etomidate

A

favorable cardiac safety, little haemodynamic instability, no analgesic properties, unsuitable for prolonged sedation, adrenal suppression.

238
Q

Botulinum toxin indications

A

blepharospasm, hemifacial spasm, focal spasticity, spasmodic torticollis, severe hyperhidrosis (axillae), achalasia

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