Pharmacology Flashcards
(156 cards)
1
Q
Adrenaline anaphylaxis: how many ml?
A
0.5ml 1:1000 IM
2
Q
adrenaline cardiac arrest
A
1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
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)
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
5
Q
amiodarone interactions (2)
A
decreased metabolism of warfarin, therefore increased INR
increased digoxin levels
6
Q
TB drug causing peripheral neuropathy
A
isoniazid
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
8
Q
finasteride how does it work?
A
inhibitor of 5 alpha-reductase
used for BPH, male pattern baldness
9
Q
adverse effects finasteride?
A
impotence
decreased libido
ejaculation disorder
gynaecomatsia
10
Q
HRT: cyclical or not?
A
cyclical for premenopausal women as replicates normal cycles and doesn’t have breakthrough bleeding
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
12
Q
Salicylate overdose (2)
A
IV bicarbonate
haemodialysis
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.
14
Q
TCA overdose
A
IV bicarbonate
15
Q
warfarin antidote if severe bleeding
A
Vit K + prothrombin complex
16
Q
heparin antidote
A
protamine sulphate
17
Q
BB antidote
A
atropine
if resistant –> glucagon
18
Q
iron overdose antedote
A
desferriozamine (chelating agent)
19
Q
lead overdose antidote
A
dimercaprol, calcium edetate
20
Q
CO overdose management
A
100% O2
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
viagra (sildenafil) and visual side effects
The blue pill, Viagra (sildenafil), causes blue discolouration of vision
26
Isoniazid (TB medication) causes peripheral neuropathy - what management
vitamin B 6 (pyridoxine)
27
When to give NAC in paracetamol overdose
- staggered overdose
- 8-24hr post ingestion
- >24hr if clearly jaundiced/ hepatic tenderness/ ALT raised
28
criteria for liver transplant in paracetamol overdose
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
causes of lung fibrosis:
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
30
prolonged QT interval
440ms in men and over 460ms in women
31
sulfalazine and lungs
lung fibrosis
32
disulfram - what does it do in alcohol?
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
acamprosate - what does it do in alcohol?
reduces craving, known to be a weak antagonist of NMDA receptors, improves abstinence in placebo controlled trials
34
Which one of the following investigations is essential prior to starting anti-tuberculosis therapy?
LFTs
35
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.
Ciprofloxacin may lead to tendinopathy
36
which antibiotics bad in pregnancy
Antibiotics
tetracyclines
aminoglycosides
sulphonamides and trimethoprim
quinolones: the BNF advises to avoid due to arthropathy in some animal studies
37
which drugs bad in pregnancy
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
gliptin - important side effect on which organ
pancreatitis
39
glitazones side effects
weight fain, fluid retention, liver dysfunction, fractures
40
sulfonylureas side effects
hypoglycaemia, increased appetite, ADH syndrome, live dysfunction
41
what causes digoxin toxicity
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
digoxin toxicity Sx
gynaecomasia
arryhtmias
gen unwell (yellow green vision)
43
management digoxin toxicity
Digibind
correct arrhythmias
monitor potassium
44
drugs causing urinary retention
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
45
IVDU use risk factor major
VTE
46
salicylate overdose (aspirin)
Both pulmonary oedema and resistant metabolic acidosis are indications for haemodialysis in salicylate overdose.
47
photosensitivity drugs
thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas
48
mechanism of action of metformin
acts by activation of the AMP-activated protein kinase (AMPK)
increases insulin sensitivity
decreases hepatic gluconeogenesis
may also reduce gastrointestinal absorption of carbohydrates
49
Which one of the following is the most common side effect of sildenafil?
headaches
50
cocaine + ACS
give diazepam
QRS widening and QT prolongation
51
Contraindicated in breastfeeding
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
52
HTN in pregnancy AND asthmatic?
Nifedipine (not labetalol)
53
management of Gestational diabetes: if the fasting plasma glucose is < 7 mmol/l
if >7?
diet and exercise for 1-2 weeks
if >7 = Start insulin
if <7 and complications e.g. hydramnios, macrosomia --> start insulin
54
Who is screened for gestational diabetes and when?
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
55
thresholds gestational diabetes OGTT
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
56
management of pre-existing diabetes in pregnancy
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
57
Intrahepatic cholestasis of pregnancy increases the risk of...
stillbirth
therefore induction of labour is generally offered at 37-38 weeks gestation
58
breastfeeding and anti-epileptic drugs
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
59
fetal movements: when to refer if not felt
not yet been felt by 24 weeks, referral should be made to a maternal fetal medicine unit
usually felt 18-20 weeks
60
RFM:
past 28 weeks what to do?
handheld doppler
--> if no HR --> US
--> if HR --> CTG for 20 mins to monitor
61
causes of folic acid deficiency? (4)
who gets 5mg folic acid? (6)
phenytoin
methotrexate
pregnancy
alcohol excess
previous pregnancy with NTD or FH NTD
antiepileptic drugs
coeliac disease
diabetes
thalassaemia
obese (>30)
62
folic acid for women - how much and until when? (2)
400mcg until 12th week pregnancy
63
Pregnancy >20 and chickenpox rash
oral acyclovir
64
chickenpox exposure in pregnancy?
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
aspirin and breastfeeding
contraindicated
66
Magnesium sulphate: what to monitor whilst giving for pre-eclampsia
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
breastfeeding: Candia infection treatment
Miconazole for mother: applied after each feed
Nystatin for oral mucosa of baby
68
Mastitis management:
when to treat? (3)
treatment (1)
'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
moderate (x2 factors)/ of 1x high risk of pre eclampsia: what medication should they have? (1)
A woman at moderate or high risk of pre-eclampsia should take aspirin 75-150mg daily from 12 weeks gestation until the birth
70
Pre-eclampsia: definition
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
High risk factors preeclampsia (5)
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
Moderate risk factors pre-eclampsia:
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
BP >160/110 in pregnancy
admit and observe
74
SSRIs of choice in breastfeeding women
sertraline and paroxetine
75
GBS screening - yes/no?
doesn't exist
76
GBS:
who to give prophylaxis?
- 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
Perineal tear:
1st --> 4th what are they? (4)
where to repair (4)
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
When is anomaly scan done?
18-20 +6 weeks
79
Dating scan date?
8 weeks
80
Nuchal scan?
11 weeks
81
methotrexate: when to stop in pregnancy?
at least 6 months before conception in both men and women
82
NSAIDS and pregnancy
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
Umbilical cord prolapse
ARound 50% of cord prolapse occurs after artificial rupture of membranes
84
UTI + breastfeeding: what management?
trimethoprim
85
Abruption:
associated factors? (5)
proteinic HTN
cocaine
multiparity
trauma
increasing maternal age
86
Active third stage:
steps (3)
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
Risk of gestational diabetes: when to do OGTT?
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
2 supplements for pregnant women
folic acid and vitamin D
89
Rhesus -ve
when to give anti-D? (2)
what to do if bleeding? (1)
what situations to give Anti-D immunoglobulin? (8)
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
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
congenital rubella
91
MMR vaccine and pregnancy - when to give?
AFTER pregnancy NOT during!
92
Cut offs iron therapy in pregnancy
1st= <110
2nd/3rd= <105
postpartum= <100
93
Physiological changes in pregnancy
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
Oligohydraminos:
causes (5)
premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia
95
rudimentary digits, limb hypoplasia and microcephaly
chicken pox
96
pregnancy and smoking risks
miscarrigage
preterm labour
stillbirth
IUGR
increased sudden unexpected death in infancy
97
alcohol and pregnancy:
Fetal alcohol syndrome:
learning difficulties
characteristic facies: smooth philtrum, thin vermilion, small palpebral fissures, epicanthic folds, microcephaly
IUGR & postnatal restricted growth
98
Stage 2 labour:
what is it? (1)
from full dilation to delivery of foetus
99
Stage 2 labour:
how long last?
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
oligohydraminos definition
<500ml
101
Early scan
10 - 13+6 weeks
102
ECV: when done?
36 weeks if breech
from 3 weeks if multiparous
103
Sudden collapse post rupture of membranes
amniotic fluid embolism
Clinical diagnosis of exclusion, as there are not definitive diagnostic tests.
104
twins + increased size of abdomen and/or SOB
twin-to-twin transfusion syndrome
in MONOChorionic twins
105
Puerperal pyrexia:
deinfition (1)
most common cause (1)
other causes (4)
management (1)
temperature of > 38ºC in the first 14 days following delivery.
endometriitis
others:
UTI
mastitis
wound infection
VTE
--> HOSPITAL for IV ABC
106
HIV and pregnancy:
how to reduce transmission to infant?
maternal antiretroviral therapy
mode of delivery (caesarean section)
neonatal antiretroviral therapy
infant feeding (bottle feeding)
107
Pre-eclampsia:
when to give brith?
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
What is Bishop score? (1)
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
Bisop score <6?
Bishop score >6?
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
PROM: management
oral erythromycin for 10/7
antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
111
Downs syndrome:
when are tests done? (1)
What happens to HCG, PAPP-A and ducal translucent? (3)
what if women miss testing? (1)
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
higher chance of Downs syndrome at 11-13+6 week scan. What to do?
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
Which UTI Abx to avoid in CKD3?
nitrofurantoin (and tetracycline)
114
Drugs to avoid renal failure
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
diuretics
115
Drugs likely to accumulate in chronic kidney disease - need dose adjustment
most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids
116
when to avoid nitrofurantoin in pregnancy?
LAST semester (risk of haemolysis in the neonate)
117
Allopurinol (gout) and azathioprine (IBD) together..
neutropenic sepsis
118
Alloporinol:
how does it work?
inhibiting xanthine oxidase.
119
Digoxin:
what monitoring is required? (1)
what is it used for? (2)
how is it monioted? (1)
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
Digoxin toxicity features
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
determined by symptoms not plasma concentration
121
Main cause of digoxin toxicitiy
hypokalaemia
122
diclofenac and cardiovascular disease
CONTRAINDICATED
123
kings college hospital criteria
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
Quinolones (ciprofloxacin and levofloxacin)
adverse effects
tendon rupture
seizures
QT
avoid in pregnancy
125
tamoxifen side ffects
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
vision changes to drugs:
blue (1)
green-yellow (1)
blue vision: Viagra ('the blue pill')
yellow-green vision: digoxin
127
what causes lithium toxicity
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
128
Herceptin (trastuzumab) adverse effects
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
allopurinol, and azathioprine
Allopurinol increases risk of azathioprine toxicity
(NEUROPENIC SEPSIS due to azathioprine)
130
digoxin drug monitoring
NONE routinely
131
monitoring of heparin
LMWH= NONE
unfractionate heparin= APTT measurement
132
adverse effects heparin
bleeding
thrombocytopenia - see below
osteoporosis and an increased risk of fractures
hyperkalaemia - this is thought to be caused by inhibition of aldosterone secretion
133
lithium In pregnacy
cardiac abnormalities= Abstains anomaly
134
chloramphenicol in pregnacy: what does it cause?
grey baby syndrome
135
urinary retention
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
136
most common SE of tamoxifen
hot flushes - 3%
(also VTE or endomeitral cancer and menstrual disturbance but less common)
137
What complications are most commonly associated with gentamicin?
(aminoglycaside) (2)
nephrotoxic AND ototoxic
138
Toxicity may be precipitated by which factors (2)
which drugs? (4)
dehydration
renal failure
drugs:
diuretics
ACEi/ ARBs
NSAID
metronidazole
139
features lithium toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
140
drug induced thrombocytopenia
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
141
cocaine toxicity: metabolic acidosis or alkalosis?
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
metformin and ACS
STOP metformin in MI as --> lactic acidosis
143
Aspirin overdose within 1hr
charcoal
144
Azathioprine monitoring
FBC LFT
145
if CCB not tolerated in step 1 for people of black African/ Carribean heritage then
thiazide like diuretic
146
amoebic liver disease treament
metronidazole
147
Diabetes drug adverse effects
lower limb amputation
bladder cancer
vit B12 def
SGLT2 inhibitor= lower limb amputaiton (FLOZIN)
bladder cancer= pioglitazone
Meformin= B12
148
DMARD with serious ocular toxicity problems
Hydroxychloroquine
149
When is CLOPIDOGREL rather than aspirin used in prevention of cardiovascular disease
ASPIRIN=
post MI
CLOPIDOGREL=
PAD
stroke
TIA
150
Benzylpenicillin vs phenoxymethylpenicillin
shorted= for meningococcal disease
LONGER= THROAT infection
151
ALT and AST in the 10,000? most likely cause
paracetamol overdose
152
doxazocin- what type of drug
alpha blocer
used 1st line BPH
153
drugs which cause digoxin toxicity
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
CYP450 and TB medications
Rif*AMP*icin = *AMP*s up CYP450
*I*soniazid = *I*nhibits
155
skin change with doxycycline
photosensitivity
156
which Abx do you get reaction with alcohol
metronidazole (
