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MSRA > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Adrenaline anaphylaxis

A

0.5ml 1:1000 IM

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2
Q

adrenaline cardiac arrest

A

1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

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3
Q

how does adrenaline work?

A

acts on α 1 and 2, β 1 and 2 receptors

(causes vasoconstriction in the skin and kidneys causing a narrow pulse pressure)

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4
Q

amioderone and skin

A

slate grey appearance

other RF: arrhythmias, thyroidm (hyper and hypo) pulmonary fibrosis, liver hepatitis, photosensitivity, bradycardia, QT lengthening, corneal depositis

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5
Q

amiodarone interactions (2)

A

decreased metabolism of warfarin, therefore increased INR

increased digoxin levels

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6
Q

TB drug causing peripheral neuropathy

A

isoniazid

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7
Q

TB side effects

A

A patient has recently started treatment for TB….
1) they noticed feeling numbness in their fingertips
2) they noticed difficulty recognising colours (optic neuritis)
3) they notices their tears are orange
4) pain in their big toe (gout/ arthralgia/ myalgia)

1) I’m-so-numb-azid (Isoniazid)
2) eye-thambutol (Ethamutol)
3) red-an-orange-pissin (Rifampicin) - hepatitis, orange secretions
4) pyrazinamide

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8
Q

finasteride how does it work?

A

inhibitor of 5 alpha-reductase

used for BPH, male pattern baldness

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9
Q

adverse effects finasteride?

A

impotence
decreased libido
ejaculation disorder
gynaecomatsia

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10
Q

HRT: cyclical or not?

A

cyclical for premenopausal women as replicates normal cycles and doesn’t have breakthrough bleeding

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11
Q

Metformin contraindications?

A
  • CKD: review if eGFR <45 , stop <30
  • lactic acidosis if tissue hypoxia (e.g. recent MI, sepsis, AKI, severe dehydration)
  • alcohol abuse
  • iodine contrast
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12
Q

Salicylate overdose (2)

A

IV bicarbonate
haemodialysis

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13
Q

benzodiazepine overdose management

A

flumazenil

(only if v severe or iatrogenic due to risk of seizures)

Flumazenil can precipitate withdrawal seizures in patients with chronic benzodiazepine use and is therefore contraindicated in this patient group.

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14
Q

TCA overdose

A

IV bicarbonate

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15
Q

warfarin antidote if severe bleeding

A

Vit K + prothrombin complex

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16
Q

heparin antidote

A

protamine sulphate

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17
Q

BB antidote

A

atropine
if resistant –> glucagon

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18
Q

iron overdose antedote

A

desferriozamine (chelating agent)

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19
Q

lead overdose antidote

A

dimercaprol, calcium edetate

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20
Q

CO overdose management

A

100% O2

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21
Q

cyanide overdose management

A

Hydroxocobalamin

22
Q

dehydration and lithium causes…

A

toxicity

normal levels = 0.4-1.0 (toxicity >1.5)

23
Q

lithium toxicity management

A

FLUIDS
monitor serum sodium closely (every 4hr with lithium level)

haemodialysis if severe toxicity

24
Q

adverse effects ahminoglycosides (gentamicin)

A

ototoxicity
nephrotoxicity

both peak (1 hour after administration) and trough levels (just before the next dose) are measured
if the trough (pre-dose) level is high the interval between the doses should be increased
if the peak (post-dose) level is high the dose should be decreased

25
Q

viagra (sildenafil) and visual side effects

A

The blue pill, Viagra (sildenafil), causes blue discolouration of vision

26
Q

Isoniazid (TB medication) causes peripheral neuropathy - what management

A

vitamin B 6 (pyridoxine)

27
Q

When to give NAC in paracetamol overdose

A
  • staggered overdose
  • 8-24hr post ingestion
  • > 24hr if clearly jaundiced/ hepatic tenderness/ ALT raised
28
Q

criteria for liver transplant in paracetamol overdose

A

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

29
Q

causes of lung fibrosis:

A

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

30
Q

prolonged QT interval

A

440ms in men and over 460ms in women

31
Q

sulfalazine and lungs

A

lung fibrosis

32
Q

disulfram - what does it do in alcohol?

A

promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase. Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms. Contraindications include ischaemic heart disease and psychosis

33
Q

acamprosate - what does it do in alcohol?

A

reduces craving, known to be a weak antagonist of NMDA receptors, improves abstinence in placebo controlled trials

34
Q

Which one of the following investigations is essential prior to starting anti-tuberculosis therapy?

A

LFTs

35
Q

A 24-year-old woman presents following a sudden, acute onset of pain at the back of the ankle whilst jogging, during which she heard a cracking sound.

A

Ciprofloxacin may lead to tendinopathy

36
Q

which antibiotics bad in pregnancy

A

Antibiotics
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones: the BNF advises to avoid due to arthropathy in some animal studies

37
Q

which drugs bad in pregnancy

A

Other drugs
ACE inhibitors, angiotensin II receptor antagonists
statins
warfarin
sulfonylureas
retinoids (including topical)
cytotoxic agents

The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk

38
Q

gliptin side effect

A

pancreatitis

39
Q

glitazones side effects

A

weight fain, fluid retention, liver dysfunction, fractures

40
Q

sulfonylureas side effects

A

hypoglycaemia, increased appetite, ADH syndrome, live dysfunction

41
Q

what causes digoxin toxicity

A

classically: hypokalaemia
digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
increasing age
renal failure
myocardial ischaemia
hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
hypoalbuminaemia
hypothermia
hypothyroidism
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

42
Q

digoxin toxicity Sx

A

gynaecomasia
arryhtmias
gen unwell (yellow green vision)

43
Q

management digoxin toxicity

A

Digibind
correct arrhythmias
monitor potassium

44
Q

drugs causing urinary retention

A

tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide

45
Q

IVDU use risk factor major

A

VTE

46
Q

salicylate overdose (aspirin)

A

Both pulmonary oedema and resistant metabolic acidosis are indications for haemodialysis in salicylate overdose.

47
Q

photosensitivity drugs

A

thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas

48
Q

mechanism of action of metformin

A

acts by activation of the AMP-activated protein kinase (AMPK)
increases insulin sensitivity
decreases hepatic gluconeogenesis
may also reduce gastrointestinal absorption of carbohydrates

49
Q

Which one of the following is the most common side effect of sildenafil?

A

headaches

50
Q

cocaine + ACS

A

give diazepam

QRS widening and QT prolongation

MSRA (9 decks)

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