- staggered overdose - plasma concentration over 100 at 4 hours or 15 at 15 hours - more than 150mg/kg - symptomatic or raised ALT or raised INR >1.3

- sinus tachycardia - QT prolongation - QTc widening

Pharmacology Flashcards by Anna Durkin

When to start NAC

staggered overdose
plasma concentration over 100 at 4 hours or 15 at 15 hours
more than 150mg/kg
symptomatic or raised ALT or raised INR >1.3

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When to consider a liver transplant in paracetamol overdose

arterial pH <7.3 24 hours after ingestion
prothrombin time >100 seconds, creatinine >300 umol/l and grade III or IV encephalopathy

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Common SE of NAC

Anaphylaxis

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How long is an infusion of NAC

1 hour

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MOA rifampicin

Inhibits bacterial DNA dependent RNH polymerase preventing transcription of DNA into mRNA

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SE rifampicin

hepatitis, orange secretions, flu-like symptoms

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MOA isoniazid

Inhibits mycolic acid synthesis

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SE isoniazid

peripheral neuropathy (antidote pyridoxine vitamin B6), hepatitis, agranulocytosis

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MOA pyrazinamide

Converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase

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SE pyrazinamide

hyperuricaemia causing gout, arthralgia, myalgia

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MOA ethambutol

inhibits the enzyme arabinosyl transferase which polymerises arabonise into arabian

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SE ethambutol

Optic neuritis - have to check visual acuity before and at 3 months as well as renal function

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TCA overdose symptoms

dilated pupils
dry mouth
seizure
coma

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TCA overdose management

IV sodium bicarbonate

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TCA ECG changes

sinus tachycardia
QT prolongation
QTc widening

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Salicyclic overdose management

urinary alkalinization with IV bicarbonate
haemodialysis

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Benzodiazepines overdose management

Flumazenil

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Lithium overdose management

Normal saline resuscitation
Haemodialysis
Sodium bicarbonate

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Warfarin overdose management

Vitamin K

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Heparin overdose management

Protamine sulphate

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Beta-blockers overdose management

If bradycardic will need atropine

Ethylene glycol overdose management

Fomepizole

Methanol overdose management

Fomepizole or haemodialysis

Organophosphate insecticides overdose management

Atropine

Digoxin overdose management

Digoxin specific antibody fragments

Iron overdose management

Desferrioxamine

Lead overdose management

Dimercaprol, calcium edetate

Carbon monoxide poisoning managemenbt

Hyperbaric oxygen

Cyanide poisoning management

Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

Ferrous sulphate overdose symptoms

RUQ pain LFTs off Diarrhoea Vomiting

Reversible SEs of anabolic steroids

Increased appetite Gastrointestinal dysfunction Mood swings Anxiety Acne Oedema Libido change Scrotal pain Erectile dysfunction Menstrual irregularities

Irreversible SEs of anabolic steroids

Hirsutism Voice pitch changes Male pattern baldness Skin striae or keloid scarring Chest pain Clitoral hypertrophy Short stature due to premature fusion of growth plates

Bleomycin SE

Pulmonary fibrosis

Drugs that cause lung fibrosis

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

Serotonin syndrome symptoms

Fever Rigidity Reduced consciousness

Serotonin syndrome onset of symptoms

Hours

Serotonin Syndrome Management

Cyproheptadine

NMS onset

Days

NMS management

Dantrolene

Methoxetamine symptoms

cerebellar ataxia dissociation

UTI antibiotic to avoid in CKD stage 3 or more

Nitrofurantoin

Thallium poisoning symptoms

painful polyneuropathy mood change alopecia

Thallium poisoning treatment

Oral prussian blue

Cannabinoid toxicity symptoms

CNS: agitation, tremor, anxiety, confusion, somnolence, syncope, hallucinations, changes in perception, acute psychosis, nystagmus, convulsions and coma. Cardiac: tachycardia, hypertension, chest pain, palpitations, ECG changes. Renal: acute kidney injury. Muscular: hypertonia, myoclonus, muscle jerking and myalgia. Other: cold extremities, dry mouth, dyspnoea, mydriasis, vomiting and hypokalaemia

UTI management pregnancy

Avoid trimethoprim in the first trimester Avoid nitrofurantoin in the third trimester

Cocaine toxicity drugs to avoid

Beta blocker as it can worsen vasoconstriction (benzodiazepines often used as treatment)

Salicylic acid ABG findings

respiratory alkalosis and metabolic acidosis

Is it normal for low or high sodium when giving IV Ig?

Hyponatraemia

Risk of tramadol and SSRI

Serotonin syndrome

Medication to avoid if taking aminophylline

Ciprofloxacin

Drugs that cause an increase in the number of epileptic fits

alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid