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1 - MSRA > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

P450 inducers

A

Phenytoin
Carbamazepine
Barbiturates (phenobarbitone)
Rifampicin
St John’s Wort
Chronic alcohol intake
Griseofulvin
Smoking

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2
Q

P450 inhibitors

A

Ciprofloxacin
Erythromycin
Isoniazid
Cimetidine
Omeprazole
Amiodarone
Allopurinol
Ketoconazole, fluconazole
Fluoxetine, sertraline
Ritonavir
Sodium valproate
Acute alcohol intake
Quinupristin

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3
Q

Side effects of rifampicin

A
  • Hepatitis
  • Orange secretions
  • Flu like symptoms
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4
Q

Side effects of isoniazid

A
  • Peripheral neuropathy
  • Hepatitis
  • Agranulocytosis
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5
Q

Side effects of pyrazinamide

A
  • Hyperuricaemia causing gout
  • Arthralgia
  • Myalgia
  • Hepatitis
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6
Q

Side effects of ethambutol

A
  • Optic neuritis
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7
Q

Side effects of amoxicllin

A

Rash with infectious mononucleosis

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8
Q

Side effects of co-amox

A

Cholestasis

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9
Q

Side effects of flucloxacillin

A

Cholestasis

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10
Q

Side effects of erythromycin

A
  • GI upset
  • Prolonged QT interval
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11
Q

Side effects of ciprofloxacin

A
  • Lower seizure threshold
  • Tendonitis
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12
Q

Side effect of metronidazole

A
  • Reaction following alcohol ingestion
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13
Q

Side effect of doxycycline

A
  • Photosensitivity
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14
Q

Side effect of trimethoprim

A
  • Rashes, including photosensitivity
  • Pruritis
  • Suppression of haematopoiesis
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15
Q

Criteria for liver transplant in paracetamol overdose

A
  • Arterial pH <7.3 24 hours after ingestion

or all of:
- Prothrombin time >100 seconds
- Creatinine >300umol/L
- Grade III or IV encepahlopathy

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16
Q

Monitoring requirements for statins

A

LFTs at baseline, 3 months and 12 months

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17
Q

Monitoring requirements for ACEi

A

U&E prior to treatment, after increasing dose, and at least annual

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18
Q

Monitoring requirements for amiodarone

A

TFT, LFT, U&E and CXR prior to treatment
TFT, LFT every 6 months

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19
Q

Monitoring requirements for methotrexate

A

FBC, U&E, and LFTs before starting treatment, and repeated weekly until therapy stabilised, thereafter monitored 2-3 monthly

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20
Q

Monitoring requirements for azathioprine

A

FBC and LFT before treatment
FBC weekly for first 4 weeks
FBC and LFT every 3 months

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21
Q

Monitoring requirements for lithium

A

TFT and U&E prior to treatment
Lithium levels weekly until stabilised then every 3 months
TFT and U&E every 6 months

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22
Q

Monitoring requirements for sodium valproate

A

LFT and FBC before treatment
LFT periodically during first 6 months

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23
Q

Monitoring requirements for glitazones

A

LFT before treatment and regularly during treatment

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24
Q

Indications for verapamil

A
  • Angina
  • Hypertension
  • Arrhythmias
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25
Q

Verapamil shouldn’t be given with … and why

A

Beta blockers
May cause heart block

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26
Q

Side effects of verapamil

A
  • Exaceberbation of heart failure
  • Constipation
  • Hypotension
  • Bradycardia
  • Flushing
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27
Q

Indications for diltiazem

A
  • Angina
  • Hypertension
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28
Q

Side effects of diltiazem

A
  • Hypotension
  • Bradycardia
  • Exacerbation of heart failure
  • Ankle swelling
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29
Q

Indication for dihydropyridine CCBs (nifedipine, amlodipine, felodipine)

A
  • Hypertension
  • Angina
  • Raynaud’s
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30
Q

Dihydropyridine vs diltiazem vs verapamil

A

Verapamil most negatively inotropic, diltiazem less than verapamil but still need caution.

Dihydropyridine affects peripheral vascular smooth muscle more than myocardium, so ok in heart failure but can cause ankle swelling

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31
Q

Side effects of dihydropyridine CCBs

A
  • Flushing
  • Headache
  • Ankle swelling
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32
Q

Precipitants of digoxin toxicity

A
  • Hypokalaemia
  • Increasing age
  • Renal failure
  • Myocardial ischaemia
  • Hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
  • Hypoalbuminaemia
  • Hypothermia
  • Hypothyroidism
  • Drugs
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33
Q

Drugs precipitating digoxin toxicity

A
  • Amiodarone
  • Quinidine
  • Verapamil
  • Diltiazem
  • Spironolactone
  • Ciclosporin
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34
Q

Paracetamol overdose management

A
  • Activated charcoal if <1 hourb ago
  • NAC
  • Liver transplant
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35
Q

Salicylate poisoning management

A
  • Urinary alkalinsation
  • Haemodialysis
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36
Q

Opiate overdose management

A

Naloxone

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37
Q

Benzodiazepine overdose management

A

Flumanezil

Usually only used in severe or iatrogenic overdises due to risk of seizures

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38
Q

TCA overdose management

A
  • IV bicarbonate
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39
Q

Lithium overdose management

A
  • Mild-moderate toxicity may respond to volume resuscitation
  • Haemodialysis in severe
  • Sodium bicarb sometimes used
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40
Q

Warfarin overdose management

A
  • Vitamin K
  • Prothrombin complex
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41
Q

Heparin overdose management

A

Protamine sulphate

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42
Q

Beta blocker overdose management

A
  • Atropine if bradycardic
  • Glucagon in resistant cases
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43
Q

Ethylene glycol poisioning management

A
  • Fomepizole
  • Haemodialysis in refractory cases

Ethanol previously used

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44
Q

Methanol poisioning management

A
  • Fomepizole or ethanol
  • Haemodialysis
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45
Q

Organophosphate poisioning management

A
  • Atropine
  • ?Pralidoxime
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46
Q

Digoxin overdose management

A

Digoxin-specific antibody fragments

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47
Q

Iron overdose management

A
  • Desferrioxamine
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48
Q

Lead poisioning management

A
  • Dimercaprol
  • Calcium edetate
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49
Q

Carbon monoxide poisoning management

A
  • 100% oxygen
  • Hyperbaric oxygen
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50
Q

Cyanide poisioning management

A
  • Hydroxycobalamin
  • Combination of amyl nitrate, sodium nitrate, and sodium thiosulfate
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51
Q

Dose adrenaline anaphylaxis

A

0.5ml 1:1,000 IM

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52
Q

Dose adrenaline cardiac arrest

A

1ml 1:1,000 (or 10ml 1:10,000)

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53
Q

Management of accidental injection of adrenaline, e.g. resulting in digital ischaemia

A

Local infiltration of phentolamine

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54
Q

Nutritional support problem drinking

A

All patients should receive thiamine if ‘diet may be deficient’

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55
Q

Management acute alcohol withdrawal

A

Benzodiazepines

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56
Q

Drug promoting alcohol abstinence

A

Disulfram

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57
Q

Contraindications disulfram

A
  • IHD
  • Psychosis
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58
Q

Drug reducing alcohol cravings

A

Acamprosate

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59
Q

Use of allopurinol

A

Gout prevention

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60
Q

When to start allopurinol in gour

A

2 weeks after attack

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61
Q

Dose allopurinol

A

Initial dose 100mg OD, titrate to aim for serum uric acid of <300

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62
Q

Drug cover when starting allopurinol

A

Colchicine (or NSAIDs if CI) - continue for 6 months

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63
Q

Indications for allopurinol

A

All patients after first attack of gout, esp if;
- ≥2 attacks in 12 months
- Tophi
- Renal disease
- Uric acid renal stones

Prophylaxis if on cytotoxics or diuretics
Lesch-Nyhan syndrome

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64
Q

Dermatological SEs allopurinol

A
  • Severe cutaneous adverse reaction (SCAR)
  • Drug reaction with eosinophilia and systemic symptoms (DRESS)
  • Stevens-Johnson syndrome

Advise patients to stop taking allopurinol immediately if develop rash

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65
Q

Groups at increased risk of dermatological SEs of gout

A

Chinese, Korean, and Thai people

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66
Q

Interactions allopurinol

A
  • Azathioprine
  • Cyclophosphamide
  • Theophylline
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67
Q

Allopurinol + azathioprine =

A

High levels of azathioprine

Much reduce dose if combo can’t be avoided

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68
Q

Allopurinol + cyclophosphamide =

A

Reduced renal clearance of cyclophosphamide → marrow toxicity

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69
Q

Allopurinol + theophylline =

A

Increase in plasma conc of theophylline

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70
Q

What is amiodarone induced thyrotoxicosis type 1

A

Excess iodine-induced thyroid hormone synthesis

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71
Q

Management amiodarone induced thyrotoxicosis type 1

A

Carbimazole or potassium perchlorate

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72
Q

What is amiodarone induced thyrotoxicosis type 2

A

Destructive thyroiditis

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73
Q

Management amiodarone induced thyrotoxicosis type 2

A

Corticosteroids

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74
Q

Is there a goitre in amiodarone induced thyrotoxicosis?

A

Yes in type 1, no in type 2

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75
Q

Drug interactions amiodarone

A

Warfarin → raised INR
Digoxin → raised dix levels

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76
Q

Aspirin interactions

A

Increases action of:
- Oral hypoglycaemics
- Warfarin
- Steroids

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77
Q

Aspirin in under 16’s

A

Should not be used due to risk of Reye’s syndrome (except Kawasakis benefit > risk)

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78
Q

Features beta blocker overdose

A
  • Bradycardia
  • Hypotension
  • Heart failure
  • Syncope
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79
Q

Management beta blocker overdose

A
  • If bradycardic, atropine
  • In resistant cases, glucagon
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80
Q

Features of CO toxicity

A
  • Headache
  • N&V
  • Vertigo
  • Confusion
  • Subjective weakness
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81
Q

Features of severe CO toxicity

A
  • Pink skin and mucosa
  • Hyperpyrexia
  • Arrhythmias
  • Extrapyramidal features
  • Coma
  • Death
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82
Q

Normal carboxyhaemoglobin levels

A

<3% in non-smokers
<10% in smokers

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83
Q

Carboxyhaemoglobin levels in CO toxicity

A

10-30% symptomatic
>30% severe toxicity

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84
Q

Management CO poisoning

A
  • 100% high flow oxygen via NRB
  • Hyperbaric oxygen in some cases
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85
Q

Timing of 100% O2 therapy in CO poisoning

A

Start ASAP, continue for a minimum of 6 hours
Continue until all symptoms resolved

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86
Q

Target O2 says in CO poisoning

A

100%

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87
Q

Indications hyperbaric oxygen in CO poisoning

A
  • > 25% carboxyhaemoglobin
  • LOC at any point
  • Neurological signs other than headache
  • Myocardial ischaemia or arrhythmia
  • Pregnancy
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88
Q

Adverse effects ciclosporin

A
  • Nephrotoxicity and hepatotoxicity
  • Fluid retention
  • Hypertension
  • Hyperkalaemia
  • Hypertrichosis
  • Gingival hyperplasia
  • Tremor
  • Impaired glucose tolerance
  • Hyperlipidaemia
  • Increased susceptibility to severe infection
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89
Q

Interactions ciclosporin

A

Cannabidiol - may increase conc of ciclosporin

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90
Q

Indications ciclosporin

A
  • Following organ transplantation
  • RA
  • Psoriasis
  • UC
  • Pure red cell aplasia
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91
Q

Cardiovascular effects cocaine

A
  • Coronary artery spasm → MI/infection
  • Tachycardia or bradycardia
  • Hypertension
  • QRS widening and QT prolongation
  • Aortic dissection
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92
Q

Neurological effects cocaine

A
  • Seizures
  • Mydriasis
  • Hypertonia
  • Hyperreflexia
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93
Q

Psychiatric effects cocaine

A
  • Agitation
  • Psychosis
  • Hallucinations
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94
Q

Other adverse effects cocaine

A
  • Ischaemic colitis
  • Hyperthermia
  • Metabolic acidosis
  • Rhabdomyolysis
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95
Q

Management chest pain caused by cocaine toxicity

A

Benzodiazepines and GTN

If MI develops, PCI

96
Q

Management hypertension caused by cocaine toxicity

A

Benzodiazepines and sodium nitroprusside

97
Q

Diclofenac vs other NSAIDs - cardiovascular risk

A

Diclofenac associated with significantly increased risk of cardiovascular events

98
Q

Contraindications diclofenac

A
  • IHD
  • Peripheral arterial disease
  • Cerebrovascular disease
  • CHD
99
Q

Best cardiovascular risk profile of NSAIDs

A

Naproxen and low-dose ibuprofen

100
Q

Monitoring of digoxin

A

Not monitored routinely, except in toxicity
If toxicity suspected, dig concentration measured within 8-12 hours of last dose

101
Q

Features digoxin toxicity

A
  • Generally unwell, lethargy, N&V, anorexia, confusion
  • Yellow-green vision
  • Arrhythmias
  • Gynaecomastia
102
Q

Management digoxin toxicity

A

Digibind
Correct arrhythmias
Monitor potassium

103
Q

Indications dopamine receptor agonists

A
  • Parkinson’s disease
  • Prolactinoma/galactorrhoea
  • Cyclical breast disease
  • Acromegaly
104
Q

Examples dopamine receptor agonists

A
  • Bromocriptine
  • Ropinirole
  • Cabergoline
  • Apomorphine
105
Q

When to start treatment in Parkinson’s disease

A

Delay treatment until onset of disabling symptoms

106
Q

Adverse effects dopamine receptor agonists

A
  • Pulmonary, retroperitoneal, and cardiac fibrosis (ergot-derived, e.g. bromocriptine, cabergoline)
  • Nausea/vomiting
  • Hallucinations
  • Daytime somnolence
107
Q

Drugs causing impaired glucose tolerance

A
  • Thiazides, furosemide
  • Steroids
  • Tacrolimus, ciclosporin
  • Interferon-alpha
  • Nicotinic acid
  • Anti-psychotics
108
Q

Drugs causing thrombocytopenia

A
  • Quinine
  • Abciximab
  • NSAIDs
  • Furosemide
  • Carbamazepine, valproate
  • Heparin
109
Q

Antibiotics causing thrombocytopenia

A
  • Penicillins
  • Sulphonamides
  • Rifampicin
110
Q

Drugs causing urinary retention

A
  • TCAs, e.g. amitriptyline
  • Anticholinergics, e.g. antipsychotics, antihistamines
  • Opioids
  • NSAIDs
  • Disopyramide
111
Q

Drugs causing lung fibrosis

A
  • Amiodarone
  • Cytotoxic agents - busulphan, bleomycin
  • Methotrexate, sulfasalazine
  • Nitrofurantoin
  • Ergot derived dopamine agonists
112
Q

What are the ergot derived dopamine agonists

A
  • Bromocriptine
  • Cabergoline
  • Pergolide
113
Q

Drugs causing cataracts

114
Q

Drugs causing corneal opacities

A
  • Amiodarone
  • Indomethacin
115
Q

Drugs causing optic neuritis

A
  • Ethambutol
  • Amiodarone
  • Metronidazole
116
Q

Drugs causing retinopathy

A

Chloroquine, quinine

117
Q

Sildanafil opthalmic SEs

A
  • Blue discolouration
  • Non-arteritic anterior ischaemic neuropathy
118
Q

Drugs causing photosensitivity

A
  • Thiazides
  • Tetracyclines, sulphonamides, ciprofloxacin
  • Amiodarone
  • NSAIDs, e.g. piroxicam
  • Psoralens
  • Sulphonylureas
119
Q

Use of syntocinon

A
  • Active management of third stage of labour to reduce risk of haemorrhage
  • Induction
120
Q

Use of ergometrine

A

Alternative to oxytocin in active management of third stage of labour

121
Q

Adverse effects ergometrine

A

Coronary artery spasm

122
Q

Use of mifepristone

A

Termination of pregnancy

123
Q

SEs mifepristone

A

Menorrhagia

124
Q

Features of ecstasy poisoning

A
  • Agitation, anxiety, confusion, ataxia
  • Tachycardia, hypertension
  • Hyponatraemia
  • Hyperthermia
  • Rhabdomyolysis
125
Q

Management ecstasy poisoning

A
  • Supportive
  • Dantrolene for hyperthermia if simple measures fail
126
Q

Indications finasteride

A
  • BPH
  • Male pattern baldness
127
Q

Adverse effects finasteride

A
  • Impotence
  • Decreased libido
  • Ejaculation disorders
  • Gynaecomastia and breast tenderness
128
Q

Finasteride and PSA

A

Decreases PSA

129
Q

Adverse effects gentamicin

A

Ototoxicity
Nephrotoxicity

130
Q

Contraindications gentamicin

A

Myasthenia gravis

131
Q

Adverse effects heparin

A
  • Bleeding
  • Thrombocytopenia
  • Osteoporosis and increased risk of fractures
  • Hyperkalaemia
132
Q

When does heparin induced thrombocytopenia develop

A

After 5-10 days of treatment

133
Q

Features heparin-induced thrombocytopenia

A

50% reduction in platelets
Thrombosis (is a PROTHROMBOTIC condition)
Skin allergy

134
Q

What is used for ongoing anticoagulation in heparin induced thrombocytopenia

A

Direct thrombin inhibitor, e.g. argatroban, or danaparoid

135
Q

Which kind of heparin highest risk of heparin induced thrombocytopenia

A

Unfractionated

136
Q

Heparin overdose treatment

A

Protamine sulphate (only partially reverses effect of LMWH)

137
Q

Duration of action unfractionated vs LMWH

A

Short in unfractionated, long in LMWH

138
Q

Monitoring of unfractionated heparin

139
Q

Monitoring LMWH

A

Anti factor Xa

140
Q

What situations is unfractionated heparin useful in

A
  • High risk of bleeding (short duration so terminated rapidly)
  • Renal failure
141
Q

Indications HRT

A
  • Vasomotor symptoms - flushing, insomnia, headaches
  • Premature menopause
142
Q

How long to continue HRT in premature menopause

143
Q

Causes of low magnesium

A
  • Drugs
  • TPN
  • Diarrhoea
  • Alcohol
  • Hypokalaemia
  • Hypercalcaemia
  • Metabolic disorders
144
Q

Drugs causing hypomagnesaemia

A
  • Diuretics
  • PPIs
145
Q

Metabolic disorders causing hypomagnesaemia

A
  • Gitleman’s
  • Bartter’s
146
Q

Features of hypomagnesaemia

A
  • Paresthesia
  • Tetany
  • Seizures
  • Arrhythmias
  • Decreased PTH secretion → hypocalcaemia
147
Q

When is IV magnesium replacement required?

A
  • Mg <0.4
  • Tetany
  • Arrhythmias
  • Seizures
148
Q

Precipitants of lithium toxicity

A
  • Dehydration
  • Renal failure
  • Drugs
149
Q

Drugs precipitating lithium toxicity

A
  • Diuretics, esp thiazides
  • ACE inhibitors/ARBs
  • NSAIDs
  • Metronidazole
150
Q

Features of lithium toxicity

A
  • Coarse tremor
  • Hyperreflexia
  • Acute confusion
  • Polyuria
  • Seizure
  • Coma
151
Q

Management mild-moderate lithium toxicity

A

Volume resuscitation with normal saline, typically twice maint rate

152
Q

Management severe lithium toxicity

A

Haemodialysis

153
Q

Examples macrolides

A

Erythromycin
Clarithromycin
Azithromycin

154
Q

Adverse effects macrolides

A
  • Prolongation of QT interval
  • GI effects
  • Cholestatic jaundice
  • P450 inhibitors
  • Hearing loss and tinnitus (azithromycin)
155
Q

Interactions macrolides

A

Statins - should be stopped whilst taking course of macrolides - increases risk of myopathy and rhabdomyolysis

156
Q

Side effects spinal anaesthesia

A
  • Hypotension
  • Sensory and motor block
  • Nausea
  • Urinary retention
157
Q

Relative CIs NSAIDs

A
  • GI bleeding or bleeding diathesis
  • Operations associated with high blood loss
  • Asthma
  • Moderate to severe renal impairment
  • Dehydration
  • History of hypersensitivity to NSAIDs or aspirin
158
Q

Use of mefloquine

A

Prophylaxis and treatment of malaria

159
Q

Advice re mefloquine

A
  • Certain SEs, e.g. nightmares, anxiety, may be prodromal of more serious neuropsychiatric effects
  • Risk of suicide and self harm
  • Adverse reactions can continue for several months
160
Q

CIs mefloquine

A

History of psychiatric disorders

161
Q

Use metformin

A

T2DM
PCOS
Non-alcoholic fatty liver disease

162
Q

Adverse effects metformin

A
  • GI upsets - nausea, anorexia, diarrhoea
  • Reduced B12 absorption (rarely clinical problem)
  • Lactic acidosis with severe liver disease or renal failure
163
Q

Contraindications to metformin

A
  • CKD
  • Iodine-containing XR media
  • Alcohol abuse (relative)
164
Q

CKD and metformin

A

Review dose if Cr >130 (GFR <45)
Stop if Cr >150 (GFR <30)

165
Q

Metformin and lactic acidosis

A

Can cause lactic acidosis if taken during period of tissue hypoxia - recent MI, sepsis, AKI, severe dehydration

166
Q

Features of opioid misuse

A
  • Rhinorrhoea
  • Needle track marks
  • Pinpoint pupils
  • Drowsiness
  • Watering eyes
  • YawningCo
167
Q

Complications opioid misuse

A
  • Infection
  • VTE
  • Resp depression and death
  • Psych problems - craving
  • Social problems
168
Q

Infections in opioid misuse

A
  • Viral infections from needle sharing - HIV, hep B and C
  • Bacterial infections from injection - infective endocarditis, septic arthritis, septicaemia, necrotising fasciitis
169
Q

First line treatment opioid detoxification

A

Methadone or buprenorphine

170
Q

Features organophosphate insecticide poisoning

A
  • Salivation
  • Lacrimation
  • Urinary
  • Defecation/diarrhoea
  • Hypotension, bradycardia
  • Small pupils
  • Muscle fasciculation
171
Q

Management organophosphate insecticide poisoning

172
Q

Management paracetamol overdose presenting within 1 hour

A

Activated charcoal (reduces absorption)

173
Q

Indications for acetylcysteine in paracetamol overdose

A
  • Plasma paracetamol concentration on or above treatment line
  • Staggered overdose or doubt about time of ingestion
  • Present within 8-24 hours after ingestion of overdose more than 150mg/kg
  • Present >24 hours if jaundiced, hepatic tenderness, abnormal ALT
174
Q

Adverse effects acetylcysteine

A

Anaphylactoid reaction

175
Q

Treatment anaphylactoid reaction to acetylcysteine

A

Stop infusion and restart at lower rate

176
Q

Criteria for liver transplantation in paracetamol overdose

A

Arterial pH <7.3 24 hours after ingestion

Or all of;
- Prothrombin time >100
- Cr >300
- Grade III or IV encephalopathy

177
Q

Use of PDE5 inhibitors

A
  • Erectile dysfunction
  • Pulmonary hypertension
178
Q

Examples PDE5 inhibitors

A
  • Sildenafil
  • Tadalafil
  • Vardenafil
179
Q

Sildenafil vs tadalafil

A

Sildenafil short acting, taken 1 hour before sexual activity
Tadalafil long acting, may be taken on regular basis

180
Q

Contraindications PDE5 inhibitors

A
  • Patients taking nitrates and related drugs e.g. nicorandil
  • Hypotension
  • Recent stroke or MI (wait 6 months)
181
Q

Side effects PDE5 inhibitors

A
  • Visual disturbances - blue discolouration, non-arteritic anterior ischaemic neuropathy
  • Nasal congestion
  • Flushing
  • GI side effects
  • Headache
  • Priapism
182
Q

Types of potassium-sparing diuretics

A

Epithelial sodium channel blockers
Aldosterone antagonists

183
Q

Examples epithelial sodium channel blockers

A

Amiloride
Triamterene

184
Q

Examples aldosterone antagonists

A

Spironolactone
Eplerenone

185
Q

Use of amiloride

A

Often given with thiazide or loop diuretics as alternative to potassium supplementation

186
Q

Use of aldosterone antagonists

A
  • Ascites
  • Heart failure
  • Nephrotic syndrome
  • Conn’s syndrome
187
Q

Drugs exacerbating heart failure

A
  • Thiazolidinediones
  • Verapamil
  • NSAIDs
  • Glucocorticoids
  • Class I anti-arrhythmics, e.g. flecainide
188
Q

Drugs to avoid in renal failure

A
  • Antibiotics - tetracycline, nitrofurantoin
  • NSAIDs
  • Lithium
  • MetforminD
189
Q

Drugs likely to accumulate in CKD

A
  • Most antibiotics
  • Digoxin
  • Atenolol
  • Methotrexate
  • Sulphonylureas
  • Furosemide
  • Opioids
190
Q

Drugs safe in renal failure

A
  • Erythromycin
  • Rifampicin
  • Diazepam
  • Warfarin
191
Q

Antibiotics contraindicated in pregnancy

A
  • Tetracyclines
  • Aminoglycosides
  • Sulphonamides
  • Trimethoprim
  • Quinolones
192
Q

Other drugs contraindicated in pregnancy

A
  • ACEi, ARBs
  • Statins
  • Warfarin
  • Sulfonylureas
  • Retinoids
  • Cytotoxic agents
193
Q

Examples quinolones

A

Ciprofloxacin
Levofloxacin

194
Q

Adverse effects quinolones

A
  • Lower seizure threshold
  • Tendon damage, including rupture
  • Cartilage damage
  • Lengthens QT
195
Q

Contraindications quinolones

A
  • Pregnancy or breastfeeding
  • G6PD
  • Avoid in children
196
Q

Blood gas salicylate overdose

A

Mixed respiratory alkalosis and metabolic acidosis

197
Q

Features salicylate overdose

A

Hyperventilation
Tinnitus
Lethargy
Sweating, pyrexia
Nausea, vomiting
Hyperglycaemia, hypoglycaemia
Seizures
ComaT

198
Q

Treatment salicylate overdose

A

General - ABC, charcoal
Urinary alkalisation with IV sodium bicarbonate
Haemodialysis

199
Q

Indications for haemodialysis in salicylate overdose

A
  • Serum conc >700mg/L
  • Metabolic acidosis resistant to treatment
  • Acute renal failure
  • Pulmonary oedema
  • Seizures
  • Coma
200
Q

SEs ACEi

A

Cough
Hyperkalaemia

201
Q

SEs bendroflumethiazide

A
  • Gout
  • Hypokalaemia
  • Hyponatraemia
  • Impaired glucose tolerance
202
Q

SEs calcium channel blockers

A
  • Headache
  • Flushing
  • Ankle oedema
203
Q

SEs beta blockers

A
  • Bronchospasm
  • Fatigue
  • Cold peripheries
204
Q

SEs doxazosin

A

Postural hypotension

205
Q

SEs metformin

A

GI side effects
Lactic acidosis

206
Q

SEs sulfonylureas

A

Hypoglycaemia episodes
Increased appetite and weight gain
SIADH
Liver dysfunction

207
Q

SEs glitazones

A

Weight gain
Fluid retention
Liver dysfunction
Fractures

208
Q

SEs gliptins

A

Pancreatitis

209
Q

SEs St Johns Wort

A
  • Serotonin syndrome
  • P450 inducer
210
Q

Use tamoxifen

A

Oestrogen receptor positive breast cancer

211
Q

Adverse effects tamoxifen

A
  • Menstrual disturbance - vaginal bleeding, amenorrhoea
  • Hot flushes
  • VTE
  • Endometrial cancer
212
Q

How long to continue tamoxifen in breast cancer

A

5 years following removal of tumour

213
Q

Tamoxifen vs raloxifene

A

Raloxifene has lower risk of endometrial cancer

214
Q

Teratogenic effects of ACEi

A
  • Renal dysgenesis
  • Craniofacial abnormalities
215
Q

Teratogenic effects alcohol

A
  • Craniofacial abnormalities
216
Q

Teratogenic effects aminoglycosides

A

Ototoxicity

217
Q

Teratogenic effects carbamazepine

A
  • Neural tube defects
  • Craniofacial abnormalities
218
Q

Teratogenic effects chloramphenicol

A

‘Grey baby’ syndrome

219
Q

Teratogenic effects cocaine

A

IUGR
Preterm labour

220
Q

Teratogenic effects diethylstilbesterol

A

Vaginal clear cell adenocarcinoma

221
Q

Teratogenic effects lithium

A

Ebstein’s anomaly

222
Q

Teratogenic effects maternal diabetes mellitus

A

Macrosomia
Neural tube defects
Polyhydraminos
Preterm labour
Caudal regression syndrome

223
Q

Teratogenic effects smoking

A

Preterm labour
IUGR

224
Q

Teratogenic effects tetracyclines

A

Discoloured teeth

225
Q

Teratogenic effects valproate

A

Neural tube defects
Craniofacial abnormalities

226
Q

Teratogenic effects warfarin

A

Craniofacial abnormalities

227
Q

Trastuzumab aka

228
Q

Use trastuzumab (herceptin)

A

Metastatic breast cancer

229
Q

Adverse effects trastuzumab (herceptin)

A

Flu like symptoms
Diarrhoea
Cardiotoxicity

230
Q

Early features TCA overdose

A
  • Dry mouth
  • Dilated pupils
  • Agitation
  • Sinus tachy
  • Blurred vision
231
Q

Features of severe TCA overdose

A
  • Arrhythmias
  • Seizures
  • Metabolic acidosis
  • Coma
232
Q

ECG changes TCA overdose

A
  • Sinus tachy
  • Widening of QRS
  • Prolongation of QT interval
233
Q

Management TCA overdose

A

IV bicarbonate
Other drugs for arrhythmia
IV lipid emulsion

234
Q

Indications for IV bicarbonate in TCA overdose

A
  • Widening of QRS interval >100
  • Ventricular arrhythmias
235
Q

Anti-arrhythmics contraindicated in TCA overdose

A

Class 1a, e.g. quinidine, and 1c, e.g. flecainide - prolong depolarisation
Class III amiodarone - prolong QT

1 - MSRA (23 decks)

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