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Pharmacology Flashcards

1
Q

What is oral allergy syndrome?

A

IgE mediated hypersensitivity to specific plant based foods

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2
Q

Test for food allergies and pollen

A

Skin prick testing

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3
Q

Test for contact dermatitis

A

Skin patch testing

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4
Q

Test for food allergies, inhaled allergens like pollen, and venom

A

RAST

Radioallergosorbent test

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5
Q

How does RAST testing work?

A

Determines amount of IgE that reacts specifically with suspected or known allergen

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6
Q

Anaphylaxis dose of adrenaline age <6 months

A

150 micrograms

0.15ml of 1 in 1000

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7
Q

Anaphylaxis dose of hydrocortisone <6 months

A

25mg

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8
Q

Anaphylaxis dose of chlorphenamine <6 months

A

250 microgram per kg

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9
Q

Anaphylaxis dose of adrenaline 6 months till 6 years

A

150 micrograms

0.15ml of 1 in 1000

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10
Q

Anaphylaxis dose of hydrocortisone 6 months till 6 years

A

50mg

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11
Q

Anaphylaxis dose of chlorphenamine 6 months till 6 years

A

2.5mg

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12
Q

Anaphylaxis dose of adrenaline 6 to 12 years

A

300 micrograms

0.3ml of 1 in 1000

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13
Q

Anaphylaxis dose of hydrocortisone 6 to 12 years

A

100mg

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14
Q

Anaphylaxis dose of chlorphenamine 6 to 12 years

A

5mg

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15
Q

Anaphylaxis dose of adrenaline >12 years

A

500 micrograms

0.5ml of 1 in 1000

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16
Q

Anaphylaxis dose of hydrocortisone >12 years

A

200mg

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17
Q

Anaphylaxis dose of chlorphenamine >12 years

A

10mg

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18
Q

What causes oral allergy syndrome?

A

cross-reaction with a non-food allergen most commonly birch pollen

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19
Q

What is the starting dose of oral morphine for a palliative patient?

A

20-30mg MR per day

5mg for break through

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20
Q

What is the breakthrough dose of morphine?

A

1/6th the daily dose of morphine

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21
Q

Options for analgesia in palliative patients with mild to moderate renal impairment

A

oxycodone

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22
Q

Options for analgesia in palliative patients with severe renal impairment

A

alfentanil
buprenorphine
fentanyl

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23
Q

What percentage should you increase the dose of opioids by in palliative patients?

A

30-50%

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24
Q

How to convert oral codeine to oral morphine

A

Divide by 10

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25
Q

How to convert oral tramadol to oral morphine

A

Divide by 10

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26
Q

How to convert oral morphine to oral oxycodone

A

Divide by 1.5 to 2

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27
Q

What are the differences in side effects between oxycodone and morphine?

A

Oxycodone has less sedation, vomiting and pruritis

but more constipation

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28
Q

What does a 12 microgram transdermal fentanyl patch equate to in oral morphine?

A

30mg oral morphine

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29
Q

What does a transdermal buprenorphine 10 microgram patch equate to in oral morphine?

A

24mg oral morphine

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30
Q

How to convert oral morphine to subcutaneous morphine

A

Divide by 2

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31
Q

How to convert oral morphine to subcutaneous diamorphine

A

Divide by 3

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32
Q

How to convert oral oxycodone to subcutaneous diamorphine

A

Divide by 1.5

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33
Q

Medications that cause postural hypotension

A 
Nitrates
Diuretics
Anticholinergics
Antidepressants
Beta blockers
L-Dopa
ACE inhibitors
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34
Q

Palliative care management of agitation and confusion

1st line, 2nd line and terminal phase

A

1st line = haloperidol

2nd line = chlorpromazine, levomepromazine

Terminal phase = midazolam

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35
Q

Treatment of nausea due to reduced gastric motility

A

Metoclopramide

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36
Q

Treatment of nausea which is chemically mediated

A

Ondansetron
Haloperidol
Levomepromazine

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37
Q

Treatment of nausea which is due to raised intracranial pressure

A

Cyclizine

Dexamethasone

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38
Q

Treatment of nausea due to vestibular system

A

Cyclizine

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39
Q

Management of hiccups in palliative care

1st line and 2nd line

A

Chlorpromazine

2nd line = haloperidol, gabapentin, dexamethasone

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40
Q

Schedule 1 drugs

A

Cannabis

Lysergide (LSD)

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41
Q

Schedule 2 drugs

A 
Diamorphine
Morphine
Pethidine
Amphetamine
Cocaine
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42
Q

Schedule 3 drugs

A

Barbituates

buprenorphine

midazolam

temazepam

tramadol

gabapentin

pregabalin

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43
Q

Schedule 4 drugs

A

Benzodiazepines, zolpidem, zopiclone

Androgeneric and anabolic steroids, hCG, somatrophin

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44
Q

Schedule 5 drugs

A

Codeine
Pholcodine
Oramorph

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45
Q

Drug interactions with amiodarone

A

Decreases metabolism of warfarin (so increased INR)

Increased digoxin levels

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46
Q

Side effects of amiodarone

A 
Thyroid dysfunction
Corneal deposits
Pulmonary fibrosis
Liver fibrosis, hepatitis
Peripheral neuropathy
Photosensitivity
Slate grey appearance
Bradycardia
Lengthens QT interval
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47
Q

What percentage of delayed prescribing scripts are used?

A

32%

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48
Q

What extra information do children need on their prescription?

A

Their age until age 12

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49
Q

Examples of quinolone antibiotics

A

Ciprofloxacin

Levofloxacin

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50
Q

What type of antibiotic is ciprofloxacin?

A

Quinolone

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51
Q

What type of antibiotic is levofloxacin?

A

Quinolone

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52
Q

Adverse effects of quinolone antibiotics

A

Lower seizure threshold in epilepsy
Tendon damage and rupture
Lengths QT interval

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53
Q

Contraindications for quinolone antibiotics

A

Pregnant or breastfeeding

Avoid in G6PD

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54
Q

Examples of macrolide antibiotics

A

Erythromycin

Clarithromycin

Azithromycin

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55
Q

Adverse effects of macrolides

A 
Prolonged QT interval
GI side effects
Cholestatic jaundice
P450 inhibitor (stop statins)

Azithromycin is associated with hearing loss and tinnitus

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56
Q

Which antibiotics associated with hearing loss?

A

Gentamicin

Azithromycin

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57
Q

Vitamin supplementation in alcoholics

A

Oral thiamine

58
Q

Drugs used in alcoholism

A

Disulfram - promotes abstinence

Acamprosate - reduces alcohol cravings

59
Q

Which drug reduces alcohol cravings?

A

Acamprosate

60
Q

Which drug causes severe reaction when alcohol is drank to promote abstinence?

61
Q

Contraindications to disulfram

A

Ischaemic heart disease

Psychosis

62
Q

What are the benefits of HRT for premature menopause?

A

Reduces cardiovascular disease
Reduces osteoporosis
Reduces risk of cognitive impairment

63
Q

Which patients should not get mefloquine?

A

Any psychiatric history

It is an antimalarial

64
Q

Common side effects of metformin

A

GI side effects

Lactic acidosis

65
Q

Common side effects of sulfonylureas

A

Hypoglycaemic episodes

Increased appetite, weight gain

SIADH

Cholestatic liver dysfunction

66
Q

Common side effects wih glitazones

A

Weight gain

Fluid retention

Liver dysfunction

Fractures

67
Q

Common side effects with gliptins

A

Pancreatitis

68
Q

Drugs that must be stopped in pregnancy (not including antibiotics)

A 
ACE I, ARBs
Statins
Warfarin
Sulfonylureas
Retinoids (including topical)
Cytotoxic agents
69
Q

Antibiotics that must not be used during pregnancy

A

Tetracyclines
Aminoglycosides
Sulphonamides
Trimethoprim

70
Q

How long after MI can you prescribe sildenafil?

71
Q

Side effects of sildenafil

A 
Blue discolouration of vsion
Nasal congestion
Flushing
GI side effects
Headache
Priapism
72
Q

Drugs to avoid in renal failure

A

Tetracyclines

Nitrofurantoin

NSAIDs

Lithium

Metformin

73
Q

Drug causes of urticaria

A

Aspirin

Penicillin

NSAIDs

Opiates

74
Q

What are alpha blockers used for?

75
Q

Examples of alpha blockers

A

Doxazosin

Tamsulosin

76
Q

What type of drug is doxazosin?

A

Alpha blocker

77
Q

What type of drug is tamsulosin?

A

Alpha blocker

78
Q

Side effects of alpha blockers

A

Postural hypotension

Drowsiness

Dyspnoea

Cough

79
Q

Monitoring for patients on statins

A

LFTs at baseline, 3 months and 12 months

80
Q

Monitoring for patients on ACE-I

A

U+E prior to treatment, after increasing dose, and annually

81
Q

Monitoring for patients on amiodarone

A

TFT, LFT, U+E, CXR prior to treatment

TFT and LFT every 6 months

82
Q

Monitoring for patients on methotrexate

A

FBC, LFT, U+E before starting treatment and then weekly until stable

Once stable every 2-3 months

83
Q

Monitoring for patients on azathioprine

A

FBC, LFT before treatment

FBC weekly for the first 4 weeks

FBC, LFT every 3 months

84
Q

Monitoring for patients on lithium

A

TFT, U+E prior to treatment

Lithium levels weekly until stabilised

TFT, U+E every 6 months

85
Q

Monitoring for patients on sodium valproate

A

LFT, FBC before treatment

LFT periodically in first 6 months

86
Q

Monitoring for patients on glitazones

A

LFT before treatment

LFT ‘regularly’ during treatment

87
Q

Contraindications to sildenafil

A 
Nitrates
Nicorandil
MI or stroke in the last 6 months
Hypotension
Need to avoid alpha blockers for 4 hours after sildenafil
88
Q

Which drugs should be prescribed by brand?

A 
CCB
Anti-epileptics
Ciclosporin and tacrolimus
Mesalazine
Lithium
Aminophylline and theophyline
Methylphenidate
CFC free beclometasone
Dry power inhaler devices
89
Q

Diclofenac contraindications

A

Ischaemic heart disease
Peripheral arterial disease
Cerebrovascular disease
Congestive heart failure class II-IV

90
Q

Which NSAIDs can be used in patients with cardiovascular disease?

A

Naproxen
Low dose ibuprofen

Diclofenac is contraindicated

91
Q

Which vaccines should be given to pregnant women?

A

Pertussis and influenza

92
Q

Drug causes of hypomagnesaemia

A

PPIs

Diuretics

Alcohol

93
Q

Side effects of tamoxifen

A

Menstrual disturbance
Hot flushes
Venous thromboembolism
Endometrial cancer

94
Q

Drugs contraindicated in heart failure

A 
Pioglitazone
Verapamil
NSAIDs
Glucocorticoids
Flecainide
95
Q

P450 inducers

A

BS CRAP GPS

Barbituates
St Johns wart
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulfonureas
96
Q

P450 inhibitors

A

SICK FACES

Sodium valproate
Isoniazid
Ciprofloxacin
Ketoconazole
Fluoxetine
Allopurinol / Amiodarone
Cimetidine / Omeprazole
Erythromycin / Clarithromycin
Sertraline
97
Q

When to take digoxin level?

A

6-12 hours post dose

98
Q

When to take lithium level?

A

12 hours post dose

99
Q

When to take ciclosporin level?

A

Trough level immediately before dose

100
Q

What determines if a women gets sequential or continuous combined HRT?

A

If had period within the last 12 months then sequential

If no period in the last 12 months then combined

101
Q

Causes of oculogyric crisis

A

Antipsychotics
Metoclopramide
Post-encephalitic Parkinson’s disease

102
Q

Management of oculogyric crisis

A

IV benztropine or procyclidine

103
Q

Which drugs precipitate lithium toxicity?

A

Diuretics - especially thiazides

ACE-I ARBs

NSAIDS

Metronidazole

104
Q

Features of lithium toxicity

A 
Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma
105
Q

Management of lithium toxicity

A

IV saline

Haemodialysis

106
Q

Drugs that worsen seizure control in epilepsy

A

Alcohol, cocaine, amphetamines

Ciprofloxacin, levofloxacin

Aminophylline, theophylline

Methylphenidate

Mefenamic acid

107
Q

Drug causes of impaired glucose tolerance

A 
Thiazides, furosemide
Steroids
Tacrolimus, ciclosporin
Interferon-alpha
Nicotinic acid
Antipsychotics
108
Q

1st line management for motion sickness

A

Hyoscine transdermal patch

109
Q

2nd line management for motion sickness

110
Q

3rd line management for motion sickness

A

Promethazine

111
Q

What is the main cause of digoxin toxicity?

A

Hypokalaemia

112
Q

Side effects of ciclosporin

A

Everything is increased - fluid, BP, K+, hair, gums, glucose

113
Q

Side effects of finasteride

A

Impotence
Decreased libido
Ejaculation disorders
Gynaecomastia and breast tenderness

114
Q

Features of organophosphate insecticide poisoning

A 
Salivation
Lacrimation
Urination
Defecation/diarrhoea
Hypotension, bradycardia
Small pupils, muscle fasciulation
115
Q

Management of organophosphate poisoning

116
Q

Which scoring system is used to assess bleeding risk before starting a NOAC?

A

ORBIT score

117
Q

How long must a patient eat gluten for prior to coeliac testing?

118
Q

Drugs that can cause drug-induced thrombocytopenia

A 
Quinine
Abciximab
NSAIDs
Furosemide
Penicillin, sulphonamides, rifampicin
Carbamazepine, valproate
Heparin
119
Q

Adrenaline dose for adults in anaphylaxis

A

0.5mg of 1 in 1,000 IM

120
Q

Adrenaline dose for adults in cardiac arrest

A

10ml of 1 in 10,000 IM

121
Q

Drug causes of gynaecomastia

A

Spironolactone
Cimetidine
Digoxin

122
Q

Features of ecstasy poisoning

A 
Agitation, anxiety, ataxia
Tachycardia, hypertension
Hyponatraemia
Hyperthermia
Rhabdomyolysis
123
Q

Most characteristic side effect of co-amoxiclav

A

Cholestasis

124
Q

Most characteristic side effect of flucloxacillin

A

Cholestasis several weeks after use

125
Q

Most characteristic side effect of erythromycin

A

GI upset

QT interval prolongation

126
Q

Most characteristic side effect of ciprofloxacin

A

Lowers seizure threshold

Tenonitis

127
Q

Most characteristic side effect of doxycycline

A

Photosensitivity

128
Q

Most characteristic side effect of trimethoprim

A

Rashes, including photosensitivity
Pruritis
Suppression of haematopoiesis

129
Q

Causes of neuroleptic malignant syndrome

A

Antipsychotics - within hours or days

Parkinson’s meds - when suddenly stopped

130
Q

Features of neuroleptic malignant syndrome

A

Pyrexia
Muscle rigidity
HTN, tachycardia, tachypnoea
Agitation, confusion

131
Q

Investigations in neuroleptic malignant syndrome

A

Raised CK

May cause AKI

132
Q

Management of neuroleptic malignant syndrome

A

Stop antipsychotic
IV fluids
Dantrolene

133
Q

Features of serotonin syndrome

A

Hyperreflexia, myoclonus, rigidity
Hyperthermia
Sweating
Confusion

134
Q

Management of serotonin syndrome

A

IV fluids

Benzodiazepines

135
Q

Side effects of metformin

A

DOES NOT cause hypoglycaemia or weight gain
GI upset
Lactic acidosis if severe illness

136
Q

Uses for metformin

A

1st line T2DM
PCOS
NAFLD

137
Q

Contraindications to metformin

A

Review dose if egfr <45 or cr >130
Stop if egfr <30 or cr >150

Stop if having contrast scan on day of scan, restart after 48 hours

Alcohol abuse

138
Q

Adverse effects of St Johns wort

A

Same side effects as placebo
Serotonin syndrome
Inducer of P450

139
Q

Most common precipitant of digoxin toxicity

A

Hypokalaemia

140
Q

Features of digoxin toxicity

A

Unwell, N+V, confusion
Yellow-green vision
Arrhythmia
Gynaecomastia

141
Q

Management of digoxin toxicity

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