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MSRA > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Adrenaline anaphylaxis: how many ml?

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

What receptors does adrenaline work on? (2)

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:
what skin complications? (2)
Cardiac? (3)
thyroid (1)
lung (1)
liver (1)
eye (1)

A

Skin:
1- slate grey appearance
2- photosensitivity

Cardiac:
1- arrhythmias
2- bradycardia
3- QT lengthening

Thyoid:
1- thyroidm (hyper and hypo)

Lung
1- pulmonary fibrosis

Liver:
1- liver hepatitis

Eye:
1- 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

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22
Q

dehydration and lithium causes…

A

toxicity

normal levels = 0.4-1.0 (toxicity >1.5)

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23
Q

lithium toxicity management

A

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

haemodialysis if severe toxicity

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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

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25
Q

viagra (sildenafil) and visual side effects

A

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

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26
Q

Isoniazid (TB medication) causes peripheral neuropathy - what management

A

vitamin B 6 (pyridoxine)

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27
Q

When to give NAC in paracetamol overdose

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

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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)

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30
Q

prolonged QT interval

A

440ms in men and over 460ms in women

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31
Q

sulfalazine and lungs

A

lung fibrosis

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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

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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

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34
Q

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

A

LFTs

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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

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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

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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

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38
Q

gliptin - important side effect on which organ

A

pancreatitis

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39
Q

glitazones side effects

A

weight fain, fluid retention, liver dysfunction, fractures

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40
Q

sulfonylureas side effects

A

hypoglycaemia, increased appetite, ADH syndrome, live dysfunction

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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

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42
Q

digoxin toxicity Sx

A

gynaecomasia
arryhtmias
gen unwell (yellow green vision)

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43
Q

management digoxin toxicity

A

Digibind
correct arrhythmias
monitor potassium

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44
Q

drugs causing urinary retention

A

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

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45
Q

IVDU use risk factor major

A

VTE

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46
Q

salicylate overdose (aspirin)

A

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

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47
Q

photosensitivity drugs

A

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

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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

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49
Q

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

A

headaches

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50
Q

cocaine + ACS

A

give diazepam

QRS widening and QT prolongation

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51
Q

Contraindicated in breastfeeding

A

The following drugs can be given to mothers who are breastfeeding:
antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin

The following drugs should be avoided:
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

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52
Q

HTN in pregnancy AND asthmatic?

A

Nifedipine (not labetalol)

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53
Q

management of Gestational diabetes: if the fasting plasma glucose is < 7 mmol/l

if >7?

A

diet and exercise for 1-2 weeks

if >7 = Start insulin

if <7 and complications e.g. hydramnios, macrosomia –> start insulin

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54
Q

Who is screened for gestational diabetes and when?

A

women who’ve previously had gestational diabetes or other risk factors:

OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal. NICE also recommend that early self-monitoring of blood glucose is an alternative to the OGTTs

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55
Q

thresholds gestational diabetes OGTT

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

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56
Q

management of pre-existing diabetes in pregnancy

A

weight loss for women with BMI of > 27 kg/m^2
stop oral hypoglycaemic agents, apart from metformin, and commence insulin
folic acid 5 mg/day from pre-conception to 12 weeks gestation
detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts
tight glycaemic control reduces complication rates
treat retinopathy as can worsen during pregnancy

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57
Q

Intrahepatic cholestasis of pregnancy increases the risk of…

A

stillbirth

therefore induction of labour is generally offered at 37-38 weeks gestation

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58
Q

breastfeeding and anti-epileptic drugs

A

Breast feeding is acceptable with nearly all anti-epileptic drugs

It is advised that pregnant women taking phenytoin are given vitamin K in the last month of pregnancy to prevent clotting disorders in the newborn

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59
Q

fetal movements: when to refer if not felt

A

not yet been felt by 24 weeks, referral should be made to a maternal fetal medicine unit

usually felt 18-20 weeks

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60
Q

RFM:
past 28 weeks what to do?

A

handheld doppler
–> if no HR –> US
–> if HR –> CTG for 20 mins to monitor

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61
Q

causes of folic acid deficiency? (4)
who gets 5mg folic acid? (6)

A

phenytoin
methotrexate
pregnancy
alcohol excess

previous pregnancy with NTD or FH NTD
antiepileptic drugs
coeliac disease
diabetes
thalassaemia
obese (>30)

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62
Q

folic acid for women - how much and until when? (2)

A

400mcg until 12th week pregnancy

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63
Q

Pregnancy >20 and chickenpox rash

A

oral acyclovir

64
Q

chickenpox exposure in pregnancy?

A

if unsure if prev infection –> Check maternal varicella antibodies

if not –> give varicella zoster immunoglobulin

if infected –> give acyclovir

antivirals should be given at day 7 to day 14 after exposure, not immediately

65
Q

aspirin and breastfeeding

A

contraindicated

66
Q

Magnesium sulphate: what to monitor whilst giving for pre-eclampsia

A

monitor reflexes + respiratory rate

urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment
- respiratory depression can occur: calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression

treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)

67
Q

breastfeeding: Candia infection treatment

A

Miconazole for mother: applied after each feed
Nystatin for oral mucosa of baby

68
Q

Mastitis management:
when to treat? (3)
treatment (1)

A

‘if systemically unwell,
if nipple fissure present
if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection

flucloxacillin for 10-14 days

69
Q

moderate (x2 factors)/ of 1x high risk of pre eclampsia: what medication should they have? (1)

A

A woman at moderate or high risk of pre-eclampsia should take aspirin 75-150mg daily from 12 weeks gestation until the birth

70
Q

Pre-eclampsia: definition

A

new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria
other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

71
Q

High risk factors preeclampsia (5)

A

hypertensive disease in a previous pregnancy
chronic kidney disease
autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension

72
Q

Moderate risk factors pre-eclampsia:

A

first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy

if 2x of these then get aspirin

73
Q

BP >160/110 in pregnancy

A

admit and observe

74
Q

SSRIs of choice in breastfeeding women

A

sertraline and paroxetine

75
Q

GBS screening - yes/no?

A

doesn’t exist

76
Q

GBS:
who to give prophylaxis?

A
  • if GBS in previous pregnancy
  • if women are to have swabs for GBS this should be offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date
    IAP should be offered to women with a previous baby with early- or late-onset GBS disease
    IAP should be offered to women in preterm labour regardless of their GBS status
    women with a pyrexia during labour (>38ºC) should also be given IAP
    benzylpenicillin is the antibiotic of choice for GBS prophylaxis
77
Q

Perineal tear:
1st –> 4th what are they? (4)
where to repair (4)

A

1st - superficial damage with no require any repair

2nd - injury perineal muscle but not anal spincter = suture on the ward

3rd - injury to perineum involving anal spincter complex (EAS AND/or IAS) = repair in theatre

4th - AND rectal mucosa
= theatre

78
Q

When is anomaly scan done?

A

18-20 +6 weeks

79
Q

Dating scan date?

A

8 weeks

80
Q

Nuchal scan?

A

11 weeks

81
Q

methotrexate: when to stop in pregnancy?

A

at least 6 months before conception in both men and women

82
Q

NSAIDS and pregnancy

A

NSAIDs may be used until 32 weeks but after this time should be withdrawn due to the risk of early close of the ductus arteriosus

83
Q

Umbilical cord prolapse

A

ARound 50% of cord prolapse occurs after artificial rupture of membranes

84
Q

UTI + breastfeeding: what management?

A

trimethoprim

85
Q

Abruption:
associated factors? (5)

A

proteinic HTN
cocaine
multiparity
trauma
increasing maternal age

86
Q

Active third stage:
steps (3)

A

uterotonic drugs
clamping of cord between 1 and 5 mins
controlled traction of cord

(10 IU oxytocin by IM injection - given after delivery anterior shoulder)

87
Q

Risk of gestational diabetes: when to do OGTT?

A

Women who are at risk of gestational diabetes should have an oral glucose tolerance test as soon as possible after booking, rather than waiting to 16-18 weeks as was previously advocated.

88
Q

2 supplements for pregnant women

A

folic acid and vitamin D

89
Q

Rhesus -ve
when to give anti-D? (2)
what to do if bleeding? (1)
what situations to give Anti-D immunoglobulin? (8)

A

Anti-D 28 and 34 weeks

if event is in 2nd/3rd trimester give large dose of anti-D and perform Kleihauer test - determines proportion of fetal RBCs present

delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

90
Q

sensorineural deafness
congenital cataracts
congenital heart disease (e.g. patent ductus arteriosus)
growth retardation
hepatosplenomegaly
purpuric skin lesions
‘salt and pepper’ chorioretinitis
microphthalmia
cerebral palsy

A

congenital rubella

91
Q

MMR vaccine and pregnancy - when to give?

A

AFTER pregnancy NOT during!

92
Q

Cut offs iron therapy in pregnancy

A

1st= <110
2nd/3rd= <105
postpartum= <100

93
Q

Physiological changes in pregnancy

A

In pregnancy there are a number of physiological changes that take place and many of these are normal. Ventilation rates are known to increase in pregnancy due to the increased demand for oxygen and the increased basal metabolic rate. Oxygen consumption can increase by as much as 20%.

For the cardiovascular system. Plasma volume increases which results in an increase heart rate, stroke volume and cardiac output. From a haematological point of view the plasma volume increased by up to 50% and the red blood cell volume increase by about 20-30%. Due to this discrepancy, the haematocrit can decrease due to the dilution effect.

94
Q

Oligohydraminos:
causes (5)

A

premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia

95
Q

rudimentary digits, limb hypoplasia and microcephaly

A

chicken pox

96
Q

pregnancy and smoking risks

A

miscarrigage
preterm labour
stillbirth
IUGR
increased sudden unexpected death in infancy

97
Q

alcohol and pregnancy:

A

Fetal alcohol syndrome:

learning difficulties
characteristic facies: smooth philtrum, thin vermilion, small palpebral fissures, epicanthic folds, microcephaly
IUGR & postnatal restricted growth

98
Q

Stage 2 labour:
what is it? (1)

A

from full dilation to delivery of foetus

99
Q

Stage 2 labour:
how long last?

A

1 hr approx
if >1 hr consider ventouse, forceps, or CS

A/W transitent bradycardia

Delivery is possible in the OP position, however labour is likely to be longer and more painful. (occipital posterior)
may spontaneously rotate

100
Q

oligohydraminos definition

A

<500ml

101
Q

Early scan

A

10 - 13+6 weeks

102
Q

ECV: when done?

A

36 weeks if breech
from 3 weeks if multiparous

103
Q

Sudden collapse post rupture of membranes

A

amniotic fluid embolism

Clinical diagnosis of exclusion, as there are not definitive diagnostic tests.

104
Q

twins + increased size of abdomen and/or SOB

A

twin-to-twin transfusion syndrome

in MONOChorionic twins

105
Q

Puerperal pyrexia:
deinfition (1)
most common cause (1)
other causes (4)
management (1)

A

temperature of > 38ºC in the first 14 days following delivery.

endometriitis

others:
UTI
mastitis
wound infection
VTE

–> HOSPITAL for IV ABC

106
Q

HIV and pregnancy:
how to reduce transmission to infant?

A

maternal antiretroviral therapy
mode of delivery (caesarean section)
neonatal antiretroviral therapy
infant feeding (bottle feeding)

107
Q

Pre-eclampsia:
when to give brith?

A

pregnant women who have mild or moderate gestational hypertension, are more than 37 week pregnant, and are showing signs of pre-eclampsia, should be recommended to give birth within 24 - 48 hours.

108
Q

What is Bishop score? (1)

A

help assess whether induction of labour will be required

a score of < 5 indicates that labour is unlikely to start without induction
a score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

109
Q

Bisop score <6?
Bishop score >6?

A

if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion

110
Q

PROM: management

A

oral erythromycin for 10/7

antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome

111
Q

Downs syndrome:
when are tests done? (1)
What happens to HCG, PAPP-A and ducal translucent? (3)
what if women miss testing? (1)

A

11-13+6 weeks

↑ HCG, ↓ PAPP-A, thickened nuchal translucency

trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower

if women book later in pregnancy the quadruple test should be offered between 15 - 20 weeks
quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A

112
Q

higher chance of Downs syndrome at 11-13+6 week scan. What to do?

A

Women who have a ‘higher chance’ combined or quadruple tests result are offered either further screening (NIPT) or diagnostic tests (amniocentesis, CVS)

NIPT= more sensitive+specific –> higher chance

113
Q

Which UTI Abx to avoid in CKD3?

A

nitrofurantoin (and tetracycline)

114
Q

Drugs to avoid renal failure

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
diuretics

115
Q

Drugs likely to accumulate in chronic kidney disease - need dose adjustment

A

most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids

116
Q

when to avoid nitrofurantoin in pregnancy?

A

LAST semester (risk of haemolysis in the neonate)

117
Q

Allopurinol (gout) and azathioprine (IBD) together..

A

neutropenic sepsis

118
Q

Alloporinol:
how does it work?

A

inhibiting xanthine oxidase.

119
Q

Digoxin:
what monitoring is required? (1)
what is it used for? (2)
how is it monioted? (1)

A

none (except in suspected toxicity)

AF rate control
SYMPTOMS of HF but not mortality

if toxicity suspected measure conc within 8-12hr of last dose

120
Q

Digoxin toxicity features

A

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

determined by symptoms not plasma concentration

121
Q

Main cause of digoxin toxicitiy

A

hypokalaemia

122
Q

diclofenac and cardiovascular disease

A

CONTRAINDICATED

123
Q

kings college hospital criteria

A

for paracetamol overdose needing liver transplant

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

124
Q

Quinolones (ciprofloxacin and levofloxacin)
adverse effects

A

tendon rupture
seizures
QT

avoid in pregnancy

125
Q

tamoxifen side ffects

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

(acts like oeastrogen)

126
Q

vision changes to drugs:
blue (1)
green-yellow (1)

A

blue vision: Viagra (‘the blue pill’)
yellow-green vision: digoxin

127
Q

what causes lithium toxicity

A

dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

128
Q

Herceptin (trastuzumab) adverse effects

A

Adverse effects
flu-like symptoms and diarrhoea are common
cardiotoxicity
more common when anthracyclines have also been used
an echo is usually performed before starting treatment

129
Q

allopurinol, and azathioprine

A

Allopurinol increases risk of azathioprine toxicity
(NEUROPENIC SEPSIS due to azathioprine)

130
Q

digoxin drug monitoring

A

NONE routinely

131
Q

monitoring of heparin

A

LMWH= NONE
unfractionate heparin= APTT measurement

132
Q

adverse effects heparin

A

bleeding
thrombocytopenia - see below
osteoporosis and an increased risk of fractures
hyperkalaemia - this is thought to be caused by inhibition of aldosterone secretion

133
Q

lithium In pregnacy

A

cardiac abnormalities= Abstains anomaly

134
Q

chloramphenicol in pregnacy: what does it cause?

A

grey baby syndrome

135
Q

urinary retention

A

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

136
Q

most common SE of tamoxifen

A

hot flushes - 3%

(also VTE or endomeitral cancer and menstrual disturbance but less common)

137
Q

What complications are most commonly associated with gentamicin?
(aminoglycaside) (2)

A

nephrotoxic AND ototoxic

138
Q

Toxicity may be precipitated by which factors (2)
which drugs? (4)

A

dehydration
renal failure

drugs:
diuretics
ACEi/ ARBs
NSAID
metronidazole

139
Q

features lithium toxicity

A

coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

140
Q

drug induced thrombocytopenia

A

quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin

141
Q

cocaine toxicity: metabolic acidosis or alkalosis?

A

The correct answer is Metabolic alkalosis. Cocaine toxicity does not typically lead to metabolic alkalosis. Instead, it often results in metabolic acidosis due to increased lactate production from tissue ischemia and rhabdomyolysis. This occurs as a result of cocaine’s sympathomimetic effects which increase the body’s demand for oxygen, leading to tissue hypoxia.

142
Q

metformin and ACS

A

STOP metformin in MI as –> lactic acidosis

143
Q

Aspirin overdose within 1hr

A

charcoal

144
Q

Azathioprine monitoring

A

FBC LFT

145
Q

if CCB not tolerated in step 1 for people of black African/ Carribean heritage then

A

thiazide like diuretic

146
Q

amoebic liver disease treament

A

metronidazole

147
Q

Diabetes drug adverse effects
lower limb amputation
bladder cancer
vit B12 def

A

SGLT2 inhibitor= lower limb amputaiton (FLOZIN)
bladder cancer= pioglitazone
Meformin= B12

148
Q

DMARD with serious ocular toxicity problems

A

Hydroxychloroquine

149
Q

When is CLOPIDOGREL rather than aspirin used in prevention of cardiovascular disease

A

ASPIRIN=
post MI

CLOPIDOGREL=
PAD
stroke
TIA

150
Q

Benzylpenicillin vs phenoxymethylpenicillin

A

shorted= for meningococcal disease

LONGER= THROAT infection

151
Q

ALT and AST in the 10,000? most likely cause

A

paracetamol overdose

152
Q

doxazocin- what type of drug

A

alpha blocer
used 1st line BPH

153
Q

drugs which cause digoxin toxicity

A

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

154
Q

CYP450 and TB medications

A

RifAMPicin = AMPs up CYP450
Isoniazid = Inhibits

155
Q

skin change with doxycycline

A

photosensitivity

156
Q

which Abx do you get reaction with alcohol

A

metronidazole (

MSRA (22 decks)

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