Pharmacology Flashcards
Resistant HTN despite optimal doses ACEi/ARB + CCB + thiazide-like diuretic. What to start?
K </= 4.5 spironolactone
(caution for reduced egfr, risk of hyperkalaemia)
K >4.5 alpha-blocker or B-blocker
(If still uncontrolled on 4 drugs, specialist advice to be sought)
Treatment for tinea capitis?
Oral griseofulvin
Or
Ketoconazole shampoo
Which antihypertensive drug means you can only take 20mg simvastatin with it?
Amlodipine
For ischaemic stroke and TIA, which anti-platelet to take for life?
Clopidogrel
Which antihypertensives can worsen glycemic control?
Thiazides ie bendroflumethiazide
Beta-blockers
Others: glucocorticoids, anti-psychotics
Side effects of peripheral acting CCB ie ‘pines’
P- Peripheral oedema
I - DIzziness
N -Nausea
E - Ebdominal pain!?
S - Sleepy - fatigue
Digoxin OD antidote?
Digoxin-specific antibody fragments
Cyanide antidote?
Hydroxacobalamin
Carbon monoxide antidote
100% OXYGEN
Lead antidote?
Dicamperol
Organophosphate insecticide antidote?
Atropine
Methanol poisoning tx?
ETHANOL
Or haemodialysis
Beta-blocker toxicity treatment?
If bradycardia —> atropine
In resistant cases —> glucagon
Warfarin antidote
Vitamin K!
Prothrombin complex
Heparin antidote?
Protamine sulphate
TCA OD antidote?
IV bicarbonate reduces seizures
Lignocaine for arrhythmias
Dialysis
Benzodiazepines OD tx?
FLUMAZENIL
Main side effects of amiodarone?
Amiodarone is a BITCH
-Blue skin discolouratio/bradycardia
-Interstitial lung disease/pulmonary fibrosis
-Thyroid (hypo and hyper)
-Corneal deposits - blindness
-Hepatotoxicity /hypotension when IV
Side effects of Digoxin?
BAD DIG!
-Blurred/yellow vision
-Arrhythmias (ectopics and bradycardias and ECG changes (ST depression, TWI)
-Diarrhoea/nausea
-Dizziness
-Insomnia
-Gynaecomastia
Adenosine side effects
FLUSHING
BRONCHOSPASM
CHEST PAIN
Which antidiabetic drug should not be used in heart failure?
Pioglitazone
-heart failure increased when combined with insulin!
-also small increased risk of bladder cancer
What family of medication is Dapaglifozin in and how does it work?
SGLT2 inhibitor (reduce the sodium-glucose co-transporter 2 in kidneys to:)
-reduce glucose reabsorption &
-increase urinary glucose exertion
Side effect of SGLT2 inhibitors?
Increased risk of UTIs
(Due to increased urinary glucose excretion - more sugar in wee!)
Examples of short acting insulins?
Onset of action?
Peak of action?
How long do they last?
Insulin aSpart, liSpro & gluliSine (all have an ‘S’!)
Onset 15 mins
Peak at 1 hour
Last 3-4 hours
One example of intermediate acting insulin?
Onset and peak of action? How long do they last?
Isophane insulin (begins with I!)
Onset 2-4 hours
Peak 6-7 hours
Last 20 hours
Long acting insulin samples?
Onset of action?
How long do they last?
Insulin detemir and insulin gLargine
Onset 1-3 hours
Last 20-24 hours
What type of antidiabetic is metformin and how does it work?
BIGUANIDE
Decreases glucogenesis and increases peripheral utilisation of glucose
(Only acts in presents of exogenous insulin so only effective is there are functioning pancreatic islet cells!)
Examples of sulfonylureas?
How do they work?
IDEs ie gliclazide
Increase insulin secretion
Example of thiazolidinedione?
How do they work?
Pioglitazone
Reduce peripheral insulin resistance
Example of DPP-4 inhibitor?
How does it work?
Sitagliptin
Increase insulin secretion and lower glucagon secretion
Patient with diabetes, diagnosed with HTN - what to start?
ACE inhibitor or ARB
(Regardless of age or race!!)
How often to measure BP in patients with diabetes and HTN and what BP to aim for?
What BP to aim for if known nephropathy/retinopathy/cerebrovascular damage?
Every 1-2 months
BP <140/90
Or <130/80 if known damage as above
Which medication to avoid in open-angle glaucoma?
Anti-muscarinics ie cyclopentolate
(as will dilate pupil and worsen blockage!)
Antidote for benzodiazepine poisoning?
FlumaZenil
(Both have Zs!)
Antidote for arsenic?
Dicamperol
Drugs used for Alzheimer’s?
Donepezil
Galantamine
Rivastigmine
Memantine
First line drug for both focal and tonic-clonic seizures?
Lamotrigine
First line treatment for absence seizures?
Ethosuximide
drugs for focal seizures?
1st line - lamotrigine
Levetiracetam (also for tonic-clonic)
Gabapentin / Pregabalin!
Step management for diabetes
1) TRIAL OF LIFESTYLE CHANGES
2) Metformin
3) Any additionals of either DPP-4i, gliclazide, sulfonylurea, Pioglitazone or SGLT-2i
First choice Tx for suspected meningococcal disease?
Benzylpenicillin
First line Tx for lower UTI?
In pregnancy?
Nitrofurantoin (if eGFR >40)
Trimethoprim (if low risk of resistance)
Pregnancy: nitrofurantoin still (avoid at term)
Acute sore throat first line abx?
Phenoxymethylpenicillin
Drug interactions with SSRIs?
Antiepileptics (reduce seizure threshold)
Antidiabetics (affect diabetic control)
Aspirin/NSAIDs/anticoagulation/antiplatelets (increased bleeding risk)
HIV protease inhibitors
Lithium (SS/NMS)
MAOIs (SS/NMS)
SNRIs (increased SS/ NMS)
Tamoxifen
Other sedative drugs
Side effects of first - generation anti psychotics?
Extrapyramidal symptoms! DAPT
-dystonic reactions (abnormal movements of face/body)
-Akathisia (motor restlessness)
-Pseudoparkinsonism - tremor, bradykinesia, rigidity
-Tardive dyskinesia (rhythmic involuntary movements)
Antipschotic side effects (not extrapyramidal):
Weight gain
Hyperprolactinaemia
Sedation
Sleep apnoea
Anticholinergic effects
Reduced seizure threshold
Impaired glucose tolerance
Neuroepileptic malignant syndrome
Pneumonia
Neutropenia
Abnormal LFTs
Photosensitivity- chlorpromazine
Rash - olanzapine/quetiapine
Diplopia - aripiprazole
Restless legs
ECG changes in anticholinergic toxicity?
Prolongation of QRS
Aspirin toxicity symptoms
Acid base disturbance?
Hyperventilating
Sweating
Nausea & vomiting
Epigastric discomfort
Tinnitus and deafness
RESPIRATORY ALKALOSIS which then is followed by METABOLIC ACIDOSIS
Centaur criteria
‘Decide FATE of abx’
Fever
Absent cough
Tender cervical lymphadenopathy
Exudate
Uncomplicated diverticulitis first line abx?
Co-amoxiclav
First line for BV?
METRONIDAZOLE
(Fishy smell on the metro!)
Common drugs that cause mouth ulcers?
Cytotoxic drugs
Nicorandil
NSAIDs
Why is tetracycline contra-indicated in pregnancy, breast-feeding and children under 12 years?
Permanent tooth staining!
What is an allele?
Different DNA sequence at the same physical locus
What is sodium valproate a risk for in pregnancy for the baby?
NEURAL TUBE DEFECTS
Drugs that increase saliva production?
Clozapine
Neostigmine
Which vaccines may contain egg protein?
Influenza
MMR
Yellow fever
What does the spleen protect against (what kind of bacteria)?
ENCAPSULATED bacteria !
Which are encapsulated bacteria?
‘SHiN SKiS’ without the ‘i’s…
Strep pneumoniae
Hib
Neisseria meningitidis
Group B Strep
Klebsiella pneumoniae
Salmonella typhi
Vaccines given to patients following splenectomy?
Pneumonoccal vaccine
Hib vaccine
Meningococcal vaccine
Influenza vaccine
Side effects of statins?
Myositis - can lead to rhabdomyolysis
GI disturbance - rarely pancreatitis
Hepatic disturbance/jaundice
Interstitial lung disease
Examples of steroid creams that are:
Mild
Moderate
Potent
Very potent
‘HELP EVERY BAD DERMATOLOGIST!
Mild- hydrocortisone
Moderate- Eumovate
Potent - Betnovate (and Cutivate)
Very potent - Dermovate
Max dose of lidocaine that can be used as local anaesthetic?
3mg/kg
Or
7mg/kg (with epenephrine) (because it causes vasoconstriction, so slower to get to the heart)
What is 1% lidocaine equivalent to? (Mg/ml)
1 gram (1000g) in 100ml
10mg/ml ie for 70kg man, you can give 70x3mg = 210mg =21ml
Where are these antibodies found and what do they do?
IgA
IgG
IgM
IgE
IgD
IgA - found in breathing passages, digestive tract, eyes, ears, vagina
-protect body surfaces exposed to outside foreign substances
IgG - all body fluids
-fighting bacterial and viral infections (‘let’s Go get ‘em!)
IgM- blood and lymph
-first antibody MADE in response to infection
IgE - lungs/skin/mucous membranes
-react to foreign substances ie pollen (Etopy!?)
IgD - blood
Antibody production
Diabetic Drugs associated with:
1) lower/extremity amputation ?
2) bladder cancer?
3) decreased vitamin B12 levels ?
1) canagliflozin (SGLT2 inhibitor)
2) pioglitazone
3) metformin
Nephrotoxic drugs?
NSAIDs
ACE-inhibitors
Phenytoin
Penicillin, rifampicin
Furosemide, thiazide diuretics
Methotrexate
Anticholinergics
TCAs
Lithium
Woman who’s symptoms have recovered wants to stop SSRI. How to stop?
Continue for further 6 months (from remission of symptoms!)
Drugs associated with lichenoid eruptions?
ACEi
NSAIDs
Methyldopa
Chloroquine
Oral antidiabetics
Thiazide diuretics
Gold
How to reverse warfarin for patient having heavy bleeding, INR >10?
Omit warfarin
Give vitK AND
Prothrombin Complex Concentrate (PCC) ie Octaplex
Treatment for head lice?
DIMETICONE
Medication used for severe acne and mod severe hirsutism?
Co-cyprindiol
Uses for goserelin?
Endometriosis
Precocious puberty
Infertility
Uterine fibroids
Breast cancer
Prostate cancer
Drugs that can be started to help patient stop smoking?
Bupropion (norepinephrine and dopamine reuptake inhibitor, and nicotine antagonist)
Varenicline - nicotinic receptor partial agonist
Drug class of tamoxifen?
Side effects of tamoxifen?
When can’t you use it?
selective estrogen receptor modulator (SERM)
Hot flushes
Nausea
Fluid retention
Vaginal bleeding/discharge
Fatigue
Skin rash
Thrombotic disease
Don’t use in pregnancy & breastfeeding!
TCA overdose symptoms
Dilated pupils
Dry mouth
Drowsiness
Sinus tachycardia / BROAD COMPLEX TACHYCARDIA - NEED ECG
Urinary retention
Increased reflexes
What drug turns urine red?
RIFAMPICIN (R = red!)
Drugs for Tb and common side effects?
2 months RIPE
4 months of RI
RIFAMPICIN - Red secretions!
Isoniazid - perIpheral neuropathy
Pyrazinamide - Hepatitis (pray 4 liver)
Ethambutol - Eyes (optic neuritis, red-green colour blindness)
Statin side effects
‘MILD’ side effects
Myositis
Interstitial lung disease
LFT derangement
Disturbance of GI/ rarely pancreatitis
Drugs that cause gingival hyperplasia?
PLEASE CUT NOW:
Phenytoin
Ciclosporin
Nifedipine (& some other CCBs)
Which drugs are used for tuberculous meningitis?
RIPE for 2 months
RI for 10 months
Live attenuated vaccines?
MY ROME TRIP
Measles
Yellow fever
Rotavirus
Oral typhoid
Mumps
Endemic Typhus
TB (BCG)
Rubella
Influenza (nasal)
Plague
What symptoms does SCID involve?
Severe combined immunodeficiency
SCID
Small - failure to thrive
Cutaneous - dermatitis
Infections (recurrent)
Diarrhoea
What type of conditions is metoclopramide used for ?
Gastritis
Gastric stasis
FUNCTIONAL bowel obstruction
Due to prokinetic action
Cyclizine is good for which conditions?
Mechanical bowel obstruction
Raised ICP
Motion sickness
What is Haloperidol good for?
Metabolic causes of vomiting ie hypercalcaemia, renal failure
Risk of Azathioprine plus ACEi?
Anaemia and myelosuppression
(A plus A = A)!
Classic side effects of metformin?
GI side effects
LACTIC ACIDOSIS
Serious Side effect of gliptins/DPP-4 inhibitors ie sitagliptin?
Pancreatitis! (Ps!)
Side effects of sulfonylureas ie gliclazide?
Hypoglycaemia
Increased appetite/weight gain
Inappropriate ADH secretion
Liver dysfunction
Side effects of glitazones ie pioglitazone?
Weight gain
Fluid retention (avoid in heart failure!)
Liver dysfunction
Fractures
Most significant side effect of hydroxychloroquine?
Retinopathy
What to prescribe to prevent peripheral neuropathy from isoniazid?
PYRIDOXINE (vitamin B6)
Side effects of SGLT-2 inhibitors ie empaGLIFLOZIN?
UTI and genital infections
Keroacidosis
Increased risk of lower limb amputation
sGLt2 = GLiflozins
Treatment for Wilson’s disease?
Penicillamine
