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MRCEM Primary > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Which receptors do opioid analgesics act on?

A

Mu (u)

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2
Q

What is the codeine to morphine conversion?

A

240mg codeine = 30mg morphine (oral)

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3
Q

What are the contra-indications to Nitrous Oxide use?

A
  • Air containing closed spaces eg pneumothorax, GI obstruction, post SCUBA dive
  • RICP (as it increases cerebral blood flow)
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4
Q

How do aminoglycosides work and give an example

A

Gentamicin

Inhibit bacterial protein synthesis by binding to the 30S subunit

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5
Q

What are the contraindications to aminoglycoside (gentamicin) use?

A

Myasthenia Gravis
Use with caution in renal disease

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6
Q

What are the advantages of ketamine as an anaesthetic agent?

A
  • Sympathetic effects (good for shocked patient)
  • No effect on respiratory drive
  • Bronchial smooth muscle relaxant (used in severe asthma)
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7
Q

What are the contraindications to ketamine as an anaesthetic agent?

A

RICP, stroke and head trauma

HTN

Severe cardiac disease

Acute porphyria’s

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8
Q

How do penicillin’s work?

A

Inhibit bacterial wall synthesis by preventing the crosslinking of peptidoglycan polymers

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9
Q

What is the main causes of resistance to penicillin’s? Which particular antibiotic is not affected by this mechanism?

A

Resistance is due to bacteria producing beta-lactamase

Flucloxacillin is resistant to the inactivation by beta-lactamase

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10
Q

What is the mechanism of action of digoxin?

A

Positive inotrope (contraction)
- inhibits NaKATPase
- increased intracellular Ca (NaCa exchange)

Negative chronotrope (rate)
- stimulate vagal activity
- ACh released
- slows rate, slows conduction, increases refractory period

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11
Q

When is digoxin contraindicated?

A
  • WPW
  • VT or VF
  • 2nd or 3rd degree heart block
  • HOCM
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12
Q

What can cause digoxin toxicity?

A
  • Hypokalaemia
  • Hypomagnesaemia
  • Hypercalcaemia
  • Hypoxia
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13
Q

How does warfarin affect PT and APTT?

A

PT grossly prolonged
APTT prolonged to a lesser degree

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14
Q

Describe the management of the following:
a) INR 5-8, no bleeding
b) INR 5-8, bleeding

A

INR 5-8, no bleeding: withhold 1-2 doses and restart at lower dose

INR 5-8, bleeding: IV vit K, restart when INR <5

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15
Q

Describe the management of the following:
a) INR >8, no bleeding
b) INR >8, bleeding

A

INR >8, no bleeding: Oral vit K, restart when INR<5

INR>8, bleeding: IV vit K, restart when INR<5

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16
Q

Describe the management of major bleeding in a warfarinised patient

A

IV vit K, Prothrombin complex concentrate

17
Q

What are the P450 inducers?

A
  • St John
  • Phenytoin/ phenobarbitol
  • Azathioprine
  • Rifampacin
  • Carbamezapine
18
Q

What are the P450 inhibitors?

A
  • Acute alcohol consumption
  • Antibiotics
  • Antidepressants
  • Amiodarone
  • Azoles
  • Cranberry juice
  • Corticosteroids
19
Q

Beta-2 Agonists should be used with caution in people with….

A
  • Arrythmias
  • HTN
  • QT prolongation
  • Diabetes
  • Hyperthyroidism
  • Hypokalaemia
20
Q

Normal saline contains what electrolytes?

A

154mmol/L Na
154mmol/L Cl

21
Q

Hartmann’s contains what electrolytes?

A

(In mmol/L)

131 Na
111 Cl
29 HCO3
5 K
2 Ca

22
Q

Describe the mechanism of action of unfractionated vs LMW heparin

A

UFH
- potentiates antithrombin III leading to inactivation of thrombin
- the heparin/antithrombin III complex also inhibits factor Xa

LMWH
- direct Xa inhibitor

23
Q

What effect with heparin have on APTT and PT

A

Prolonged APTT
(and less so PT)

24
Q

What is the antidote to heparin used in major haemorrhage?

A

Protamine sulphate

25
Q

Your patient doesn’t improve following adrenaline given for an anaphylactic reaction to nuts…. what prescription drug might they be taking and how is it managed?

A

Beta-blockers

Give glucagon

26
Q

Antacids can increase and decrease absorption of what drugs?

A

INCREASE:
- Levodopa
- Sudafed

DECREASE:
- Chlorpromazine
- Digoxin
- Isoniazid
- Phenytoin

27
Q

What class of antibiotic is vancomycin and what is its mechanism of action?

A

Glycopeptide

Inhibits peptidogylcan activity leading to reduced cell membrane activity and increased cell lysis

28
Q

What is the mechanism of action of statins?

A

Competitively inhibit HMG-CoA to reduced LDL cholesterol levels by slowing production and increasing removal by the liver

29
Q

Describe the mechanism of action of theophylline

A

It’s a xanthine
- inhibits phosphodiesterase = increased tissue concentration of cAMP

30
Q

Which electrolyte abnormality can the use of theophylline cause?

A

Hypokalaemia

31
Q

What are the side effects of quinolones (ciprofloxacin)?

A
  • Prolonged QT
  • Tendon rupture
  • Reduced seizure threshold
  • Photosensitivity
  • Colitis
32
Q

What class of drug is ipratropium bromide?

A

short acting, anti-muscarinic, bronchodilator

33
Q

What are the side effects of ipratropium bromide?

A
  • Dry mouth and nose
  • Acute closed-angle glaucoma
  • Urinary retention
34
Q

What is the mechanism of action of NSAIDs?

A

COX1 and COX2 inhibitors leading to reduced production of prostaglandins

35
Q

What are the contraindications to lithium use?

A
  • Hyponatraemia (including thiazides)
  • Addison’s disease
  • Brugada
  • Epilepsy (reduces seizure threshold)
  • QT prolongation
36
Q

When do you take a blood sample to monitor lithium levels?

A

12 hours after the dose

37
Q

What can predispose to lithium toxicity?

A
  • Dehydration
  • Reduced renal function
  • Infections
  • Diuretics
  • NSAIDs

MRCEM Primary (6 decks)

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