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1MSRA - Learning Points > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Which drug can cause ototoxicity and nephrotoxicity?

Which disease is it contrindicated in?

A

Gentamicin

Myasthenia Gravis

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2
Q

How do you treat beta blocker overdose? What if 1st line doesn’t work?

A

Give atropine if bradycardic

If doesn’t work, give IV glucagon
(acts on glucagon receptors on heart, bypassing beta blockade)

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3
Q

How do you treat aspirin overdose? What are the criteria for haemodialysis?

A

IV bicarbonate

Haemodialysis criteria are acidosis, pulmonary oedema, seizure, coma..

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4
Q

What are the symptoms of CO poisoning?

A

Headache, confusion

Nausea vomiting

Cherry pink lips/mucosa

History of student accommodation/poorly maintained housing

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5
Q

Which investigation in suspected CO poisoning?

A

ABG!

Not pulse oximetry (will be artificially high from CO)

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6
Q

What symptoms does pesticide poisoning cause and why?

A

parasympathetic overactivation…
(because it inhibits acetylcholinesterase)
so increase in ACh

bradycardia
salivation
lacrimation
urination
diarrhoea

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7
Q

How to treat pesticide poisoning?

A

Atropine

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8
Q

Symptoms of lithium toxicity?

A

Coarse tremor
Acute Confusion
Hyperreflexia

CAH

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9
Q

Which NSAID is contra-indicated in CVS/VAscular disease?

A

Diclofenac!

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10
Q

Definition of prolonged QTc?

A

men >440
women >460

> 500 = increased risk TdP

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11
Q

Enzyme inducers

A

CRAP GPS induces rage
(St Johns wort)

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12
Q

Enzyme inhibitors

A

SICKFACE.COM Group

(Grapefruit juice)

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13
Q

What is danger of TCA overdose?
How do you treat overdose?

A

Metabolic acidosis and heart arrhythmia

Therefore, IV bicarbonate

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14
Q

Which medications can’t be used with methotrexate and why?

A

Trimethoprim
Co-trimoxazole

(they are both folate antagonists)

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15
Q

What medication can’t be given with Viagra?

A

Nitrates and nicorandil, due to over vasodilation and hypotension risk

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16
Q

What are features of lithium toxicity?

A

CAH

Coarse tremor (fine tremor at therapeutic levels)
Acute confusion
Hyperreflexia

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17
Q

What is therapeutic and toxic range of lithium?

A

0.4 - 1 therapeutic

> 1.5 toxicity seen

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18
Q

What can precipitate lithium toxicity?

A

Dehydration (D+V)
Kidney injury (including NSAID use)

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19
Q

Management of lithium toxicity?

A

IV Fluids to become euvolaemic
Then run mainatencne fluids at twice normal rate
Check Na 4hrly along with Lithium levels

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20
Q

Dose of adrenaline in anaphylaxis?

A

1:1000 IM 0.5mg

(in cardiac arrest it is 1:10,000 IV 1mg)

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21
Q

Which drugs cause urinary retention?

A

TCAs (e.g. amitriptyline)
Anticholinergics
Opioids!

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22
Q

Side effects of metformin?

A

GI upset

Lactic acidosis, because it promotes anaerobic respiration (particularly issue if preceding event which has caused Ischaemia such as MI)

23
Q

Side effects of sulphonylureas (gliclazide, glimperide)?

A

Hypoglycaemia
Weight gain
SIADH!!!

24
Q

Side effects of pioglitazone?

A

Fluid retention

25
Q

Side effect of tamoxifen?

A

Is a SERM
Therefore through down modulating oestrogen receptors, can mimic symptoms of menopause - i.e. hot flushes!

(Also risk of endometrial cancer)

26
Q

Which bloods need to be monitored on amiodarone?

A

TFT and LFTs
(amiodarone contains iodine, disrupts thyroid function and can cause hypo and hyperthyroidism)
(can also cause hepatotoxicity)

27
Q

Which bloods need to be monitored on lithium?

A

FBC, UEs, TFTs
(lithium can affect thyroid function - can cause autoimmune Hashimoto’s thyroiditis)

28
Q

Side effects of amiodarone?

A

Prolongs QT (is anantiarryhtmic which works by prolonging QT to get help terminate ventricular arrhythmia)

Can cause other arrhythmias however

Thyroid dysfunction
Pulmonary fibrosis

29
Q

Side effects of TB meds?

A

Rifampicin - hepatoxicity, orange secretions

Isoniazid - peripheral neuropathy (prevent by giving vit B6 pyridoxine)

Pyrizinamide - hepatotoxicity

Ethambutol - optic neuritis

30
Q

When should mefloquine not be given?

A

history of depression/anxiety

(is an anti-malarial)

31
Q

Antidote to methanol poisoning?

A

Fomepizole (inhibits alcohol dehydrogenase)

32
Q

Should you routinely monitor digoxin levels?

A

No, only If suspect toxicity

Toxicity can occur at normal levels

33
Q

Symptoms of digoxin toxicity? what can precipitate?

A

Lethargy
Vision changes - yellow green vision
Nausea

Hypokalaemia
Loop and thiazide diuretics

Rate limiting CCBs (diltiazem, verapamil)
Spironoloactone

34
Q

Antidote to benzo overdose?

A

Flumezanil (if cause is iatrogenic e.g. GA)

Otherwise, usually just supportive care. Because if someone who chronically uses benzos, overdoses, flumezanil can cause seizures.

35
Q

How soon can you test paracetamol after an OD?

A

4hrs
(time it takes for all the paracetamol to be absorbed - taking any sooner will underestimate extent of overdose)

36
Q

What are the King’s College Criteria for liver transplantation in paracetamol overdose?

A

Acidotic after a day
(i.e. pH <7.3 after 24hrs)

OR
All of below:
(basically hepatorenal failure)
PT >100 seconds
Creatinine >300
Grade 3 or 4 encephalopathy

37
Q

How does metformin work?

A

Stops liver producing new glucose (gluconeogenesis) and increases insulin sensitivity

38
Q

When should you not prescribe nitrofurantoin? Why?

A
  1. Avoid in third trimester of pregnancy (causes haemolysis of newborn)
  2. In CKD stage 3 or worse
    Nitrofurantoin is a prodrug. Needs bacteria to convert it to active form. Needs to be adequately concentrated by working kidneys - otherwise won’t work. Also will build up in circulation and eventually human enzymes convert it to free radicals which can cause irreversible peripheral neuropathy!
39
Q

What are the CYp450 inhibitors?

A

SICKFACES.COM

Sodium Valproate
Isoniazid
Cemitidine
Ketoconazole
Fluconazole
Acute Alcohol + Grapefruit Juice
Ciprolfloxacin
Erythromycin
Sulfsalazine
Chloramphenicol
Omeprazole
Metronidazole

40
Q

What are the CYP450 inducers?

A

CRAP GPS

Carbamazapine
Rifampicin
Alcohol (chronic)
Phenytoin

Gleofulvin
Phenobarbitone
Sulfonylureas

41
Q

What is a side effect of doxycycline?

A

Photosensitivity

42
Q

What is a side effect of amoxicillin

A

Causes maculopapular rash in glandular fever

43
Q

What do you need to be careful of when prescribing azathioprine/allopurinol?

A

NEVER PRESCRIBE THE TWO TOGETHER

Azathoprine is prodrug, converted to 6 mercaptopurine. Xanthine oxidise then converts this to uric acid.

Allopurinol inhibits xanthine oxidase, causing build up of 6-MP which causes myelosuppression and potentially neutropenic sepsis!

44
Q

How soon after overdose can you give activated charcoal?

How soon can you do gastric lavage?

A

1hr

lavage - 1-2hrs

45
Q

What are the important vs less important side effects of beta blockers?

A

IMPORTANT
BRONCHOSPASM
BRADYCARDIA

Less important
headaches
erectile dysfunction
sleep disturbance
insomnia
cold peripheries

46
Q

Important adverse effects of ciprofloxacin?

A

Lowers seizure threshold

Achilles tendonitis +/- rupture

47
Q

What is Herceptin used for and what must you do when using?

A

HER positive breast cancer

Can cause cardiomyopathy, so needs Echo prior to treatment and during, to check LVEF.

48
Q

What are the symptoms/signs of aspirin toxicity?

A

Classic picture of mixed respiratory alkalosis (as resp centre stimulated initially) and metabolic acidosis (direct effect of drug plus renal failure it causes)

Can cause tinnitus due to ototoxicity
(aminoglycosides can also do this)

49
Q

Which bloods need to be monitored with statin use in first 12 months, aside from lipids?

A

LFTs

(CK not indicated unless muscle symptoms)

50
Q

Aside from thyroid dsyfunction, pulmonary fibrosis, hepatotoxicity, long QT, what other side effects can amiodarone cause?

A

Ocular - corneal opacities, optic neuritis

51
Q

Side effects of aminoglycosides?

A

Includes gentamicin and amikacin

they cause nephrotoxicity and ototoxicity

CAN’T BE USED IN MYASTHENIA GRAVIS

52
Q

What blood test needs to be monitored when on pioglitazone or sodium valproate?

A

LFTs

(as do TB drugs, amiodarone, statins)

53
Q

Can you take Lithium in pregnancy?

A

No! It causes Ebstein’s anomaly = atrialization of right ventricle

54
Q

Mechanism of action of aspirin?

A

Non reversible COX 1 and 2 inhibitor, so reduces production of prostaglandins and thromboxane A2

1MSRA - Learning Points (20 decks)

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