Pharmacology Flashcards
1
Q
P450 inducers
A
Phenytoin
Carbamazepine
Barbiturates (phenobarbitone)
Rifampicin
St John’s Wort
Chronic alcohol intake
Griseofulvin
Smoking
2
Q
P450 inhibitors
A
Ciprofloxacin
Erythromycin
Isoniazid
Cimetidine
Omeprazole
Amiodarone
Allopurinol
Ketoconazole, fluconazole
Fluoxetine, sertraline
Ritonavir
Sodium valproate
Acute alcohol intake
Quinupristin
3
Q
Side effects of rifampicin
A
- Hepatitis
- Orange secretions
- Flu like symptoms
4
Q
Side effects of isoniazid
A
- Peripheral neuropathy
- Hepatitis
- Agranulocytosis
5
Q
Side effects of pyrazinamide
A
- Hyperuricaemia causing gout
- Arthralgia
- Myalgia
- Hepatitis
6
Q
Side effects of ethambutol
A
- Optic neuritis
7
Q
Side effects of amoxicllin
A
Rash with infectious mononucleosis
8
Q
Side effects of co-amox
A
Cholestasis
9
Q
Side effects of flucloxacillin
A
Cholestasis
10
Q
Side effects of erythromycin
A
- GI upset
- Prolonged QT interval
11
Q
Side effects of ciprofloxacin
A
- Lower seizure threshold
- Tendonitis
12
Q
Side effect of metronidazole
A
- Reaction following alcohol ingestion
13
Q
Side effect of doxycycline
A
- Photosensitivity
14
Q
Side effect of trimethoprim
A
- Rashes, including photosensitivity
- Pruritis
- Suppression of haematopoiesis
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
16
Q
Monitoring requirements for statins
A
LFTs at baseline, 3 months and 12 months
17
Q
Monitoring requirements for ACEi
A
U&E prior to treatment, after increasing dose, and at least annual
18
Q
Monitoring requirements for amiodarone
A
TFT, LFT, U&E and CXR prior to treatment
TFT, LFT every 6 months
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
20
Q
Monitoring requirements for azathioprine
A
FBC and LFT before treatment
FBC weekly for first 4 weeks
FBC and LFT every 3 months
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
22
Q
Monitoring requirements for sodium valproate
A
LFT and FBC before treatment
LFT periodically during first 6 months
23
Q
Monitoring requirements for glitazones
A
LFT before treatment and regularly during treatment
24
Q
Indications for verapamil
A
- Angina
- Hypertension
- Arrhythmias
25
Verapamil shouldn't be given with ... and why
Beta blockers
May cause heart block
26
Side effects of verapamil
- Exaceberbation of heart failure
- Constipation
- Hypotension
- Bradycardia
- Flushing
27
Indications for diltiazem
- Angina
- Hypertension
28
Side effects of diltiazem
- Hypotension
- Bradycardia
- Exacerbation of heart failure
- Ankle swelling
29
Indication for dihydropyridine CCBs (nifedipine, amlodipine, felodipine)
- Hypertension
- Angina
- Raynaud's
30
Dihydropyridine vs diltiazem vs verapamil
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
31
Side effects of dihydropyridine CCBs
- Flushing
- Headache
- Ankle swelling
32
Precipitants of digoxin toxicity
- Hypokalaemia
- Increasing age
- Renal failure
- Myocardial ischaemia
- Hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
- Hypoalbuminaemia
- Hypothermia
- Hypothyroidism
- Drugs
33
Drugs precipitating digoxin toxicity
- Amiodarone
- Quinidine
- Verapamil
- Diltiazem
- Spironolactone
- Ciclosporin
34
Paracetamol overdose management
- Activated charcoal if <1 hourb ago
- NAC
- Liver transplant
35
Salicylate poisoning management
- Urinary alkalinsation
- Haemodialysis
36
Opiate overdose management
Naloxone
37
Benzodiazepine overdose management
Flumanezil
Usually only used in severe or iatrogenic overdises due to risk of seizures
38
TCA overdose management
- IV bicarbonate
39
Lithium overdose management
- Mild-moderate toxicity may respond to volume resuscitation
- Haemodialysis in severe
- Sodium bicarb sometimes used
40
Warfarin overdose management
- Vitamin K
- Prothrombin complex
41
Heparin overdose management
Protamine sulphate
42
Beta blocker overdose management
- Atropine if bradycardic
- Glucagon in resistant cases
43
Ethylene glycol poisioning management
- Fomepizole
- Haemodialysis in refractory cases
Ethanol previously used
44
Methanol poisioning management
- Fomepizole or ethanol
- Haemodialysis
45
Organophosphate poisioning management
- Atropine
- ?Pralidoxime
46
Digoxin overdose management
Digoxin-specific antibody fragments
47
Iron overdose management
- Desferrioxamine
48
Lead poisioning management
- Dimercaprol
- Calcium edetate
49
Carbon monoxide poisoning management
- 100% oxygen
- Hyperbaric oxygen
50
Cyanide poisioning management
- Hydroxycobalamin
- Combination of amyl nitrate, sodium nitrate, and sodium thiosulfate
51
Dose adrenaline anaphylaxis
0.5ml 1:1,000 IM
52
Dose adrenaline cardiac arrest
1ml 1:1,000 (or 10ml 1:10,000)
53
Management of accidental injection of adrenaline, e.g. resulting in digital ischaemia
Local infiltration of phentolamine
54
Nutritional support problem drinking
All patients should receive thiamine if 'diet may be deficient'
55
Management acute alcohol withdrawal
Benzodiazepines
56
Drug promoting alcohol abstinence
Disulfram
57
Contraindications disulfram
- IHD
- Psychosis
58
Drug reducing alcohol cravings
Acamprosate
59
Use of allopurinol
Gout prevention
60
When to start allopurinol in gour
2 weeks after attack
61
Dose allopurinol
Initial dose 100mg OD, titrate to aim for serum uric acid of <300
62
Drug cover when starting allopurinol
Colchicine (or NSAIDs if CI) - continue for 6 months
63
Indications for allopurinol
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
64
Dermatological SEs allopurinol
- 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
65
Groups at increased risk of dermatological SEs of gout
Chinese, Korean, and Thai people
66
Interactions allopurinol
- Azathioprine
- Cyclophosphamide
- Theophylline
67
Allopurinol + azathioprine =
High levels of azathioprine
Much reduce dose if combo can't be avoided
68
Allopurinol + cyclophosphamide =
Reduced renal clearance of cyclophosphamide → marrow toxicity
69
Allopurinol + theophylline =
Increase in plasma conc of theophylline
70
What is amiodarone induced thyrotoxicosis type 1
Excess iodine-induced thyroid hormone synthesis
71
Management amiodarone induced thyrotoxicosis type 1
Carbimazole or potassium perchlorate
72
What is amiodarone induced thyrotoxicosis type 2
Destructive thyroiditis
73
Management amiodarone induced thyrotoxicosis type 2
Corticosteroids
74
Is there a goitre in amiodarone induced thyrotoxicosis?
Yes in type 1, no in type 2
75
Drug interactions amiodarone
Warfarin → raised INR
Digoxin → raised dix levels
76
Aspirin interactions
Increases action of:
- Oral hypoglycaemics
- Warfarin
- Steroids
77
Aspirin in under 16's
Should not be used due to risk of Reye's syndrome (except Kawasakis benefit > risk)
78
Features beta blocker overdose
- Bradycardia
- Hypotension
- Heart failure
- Syncope
79
Management beta blocker overdose
- If bradycardic, atropine
- In resistant cases, glucagon
80
Features of CO toxicity
- Headache
- N&V
- Vertigo
- Confusion
- Subjective weakness
81
Features of severe CO toxicity
- Pink skin and mucosa
- Hyperpyrexia
- Arrhythmias
- Extrapyramidal features
- Coma
- Death
82
Normal carboxyhaemoglobin levels
<3% in non-smokers
<10% in smokers
83
Carboxyhaemoglobin levels in CO toxicity
10-30% symptomatic
>30% severe toxicity
84
Management CO poisoning
- 100% high flow oxygen via NRB
- Hyperbaric oxygen in some cases
85
Timing of 100% O2 therapy in CO poisoning
Start ASAP, continue for a minimum of 6 hours
Continue until all symptoms resolved
86
Target O2 says in CO poisoning
100%
87
Indications hyperbaric oxygen in CO poisoning
- >25% carboxyhaemoglobin
- LOC at any point
- Neurological signs other than headache
- Myocardial ischaemia or arrhythmia
- Pregnancy
88
Adverse effects ciclosporin
- Nephrotoxicity and hepatotoxicity
- Fluid retention
- Hypertension
- Hyperkalaemia
- Hypertrichosis
- Gingival hyperplasia
- Tremor
- Impaired glucose tolerance
- Hyperlipidaemia
- Increased susceptibility to severe infection
89
Interactions ciclosporin
Cannabidiol - may increase conc of ciclosporin
90
Indications ciclosporin
- Following organ transplantation
- RA
- Psoriasis
- UC
- Pure red cell aplasia
91
Cardiovascular effects cocaine
- Coronary artery spasm → MI/infection
- Tachycardia or bradycardia
- Hypertension
- QRS widening and QT prolongation
- Aortic dissection
92
Neurological effects cocaine
- Seizures
- Mydriasis
- Hypertonia
- Hyperreflexia
93
Psychiatric effects cocaine
- Agitation
- Psychosis
- Hallucinations
94
Other adverse effects cocaine
- Ischaemic colitis
- Hyperthermia
- Metabolic acidosis
- Rhabdomyolysis
95
Management chest pain caused by cocaine toxicity
Benzodiazepines and GTN
If MI develops, PCI
96
Management hypertension caused by cocaine toxicity
Benzodiazepines and sodium nitroprusside
97
Diclofenac vs other NSAIDs - cardiovascular risk
Diclofenac associated with significantly increased risk of cardiovascular events
98
Contraindications diclofenac
- IHD
- Peripheral arterial disease
- Cerebrovascular disease
- CHD
99
Best cardiovascular risk profile of NSAIDs
Naproxen and low-dose ibuprofen
100
Monitoring of digoxin
Not monitored routinely, except in toxicity
If toxicity suspected, dig concentration measured within 8-12 hours of last dose
101
Features digoxin toxicity
- Generally unwell, lethargy, N&V, anorexia, confusion
- Yellow-green vision
- Arrhythmias
- Gynaecomastia
102
Management digoxin toxicity
Digibind
Correct arrhythmias
Monitor potassium
103
Indications dopamine receptor agonists
- Parkinson's disease
- Prolactinoma/galactorrhoea
- Cyclical breast disease
- Acromegaly
104
Examples dopamine receptor agonists
- Bromocriptine
- Ropinirole
- Cabergoline
- Apomorphine
105
When to start treatment in Parkinson's disease
Delay treatment until onset of disabling symptoms
106
Adverse effects dopamine receptor agonists
- Pulmonary, retroperitoneal, and cardiac fibrosis (ergot-derived, e.g. bromocriptine, cabergoline)
- Nausea/vomiting
- Hallucinations
- Daytime somnolence
107
Drugs causing impaired glucose tolerance
- Thiazides, furosemide
- Steroids
- Tacrolimus, ciclosporin
- Interferon-alpha
- Nicotinic acid
- Anti-psychotics
108
Drugs causing thrombocytopenia
- Quinine
- Abciximab
- NSAIDs
- Furosemide
- Carbamazepine, valproate
- Heparin
109
Antibiotics causing thrombocytopenia
- Penicillins
- Sulphonamides
- Rifampicin
110
Drugs causing urinary retention
- TCAs, e.g. amitriptyline
- Anticholinergics, e.g. antipsychotics, antihistamines
- Opioids
- NSAIDs
- Disopyramide
111
Drugs causing lung fibrosis
- Amiodarone
- Cytotoxic agents - busulphan, bleomycin
- Methotrexate, sulfasalazine
- Nitrofurantoin
- Ergot derived dopamine agonists
112
What are the ergot derived dopamine agonists
- Bromocriptine
- Cabergoline
- Pergolide
113
Drugs causing cataracts
Steroids
114
Drugs causing corneal opacities
- Amiodarone
- Indomethacin
115
Drugs causing optic neuritis
- Ethambutol
- Amiodarone
- Metronidazole
116
Drugs causing retinopathy
Chloroquine, quinine
117
Sildanafil opthalmic SEs
- Blue discolouration
- Non-arteritic anterior ischaemic neuropathy
118
Drugs causing photosensitivity
- Thiazides
- Tetracyclines, sulphonamides, ciprofloxacin
- Amiodarone
- NSAIDs, e.g. piroxicam
- Psoralens
- Sulphonylureas
119
Use of syntocinon
- Active management of third stage of labour to reduce risk of haemorrhage
- Induction
120
Use of ergometrine
Alternative to oxytocin in active management of third stage of labour
121
Adverse effects ergometrine
Coronary artery spasm
122
Use of mifepristone
Termination of pregnancy
123
SEs mifepristone
Menorrhagia
124
Features of ecstasy poisoning
- Agitation, anxiety, confusion, ataxia
- Tachycardia, hypertension
- Hyponatraemia
- Hyperthermia
- Rhabdomyolysis
125
Management ecstasy poisoning
- Supportive
- Dantrolene for hyperthermia if simple measures fail
126
Indications finasteride
- BPH
- Male pattern baldness
127
Adverse effects finasteride
- Impotence
- Decreased libido
- Ejaculation disorders
- Gynaecomastia and breast tenderness
128
Finasteride and PSA
Decreases PSA
129
Adverse effects gentamicin
Ototoxicity
Nephrotoxicity
130
Contraindications gentamicin
Myasthenia gravis
131
Adverse effects heparin
- Bleeding
- Thrombocytopenia
- Osteoporosis and increased risk of fractures
- Hyperkalaemia
132
When does heparin induced thrombocytopenia develop
After 5-10 days of treatment
133
Features heparin-induced thrombocytopenia
50% reduction in platelets
Thrombosis (is a PROTHROMBOTIC condition)
Skin allergy
134
What is used for ongoing anticoagulation in heparin induced thrombocytopenia
Direct thrombin inhibitor, e.g. argatroban, or danaparoid
135
Which kind of heparin highest risk of heparin induced thrombocytopenia
Unfractionated
136
Heparin overdose treatment
Protamine sulphate (only partially reverses effect of LMWH)
137
Duration of action unfractionated vs LMWH
Short in unfractionated, long in LMWH
138
Monitoring of unfractionated heparin
APTT
139
Monitoring LMWH
Anti factor Xa
140
What situations is unfractionated heparin useful in
- High risk of bleeding (short duration so terminated rapidly)
- Renal failure
141
Indications HRT
- Vasomotor symptoms - flushing, insomnia, headaches
- Premature menopause
142
How long to continue HRT in premature menopause
Until 50
143
Causes of low magnesium
- Drugs
- TPN
- Diarrhoea
- Alcohol
- Hypokalaemia
- Hypercalcaemia
- Metabolic disorders
144
Drugs causing hypomagnesaemia
- Diuretics
- PPIs
145
Metabolic disorders causing hypomagnesaemia
- Gitleman's
- Bartter's
146
Features of hypomagnesaemia
- Paresthesia
- Tetany
- Seizures
- Arrhythmias
- Decreased PTH secretion → hypocalcaemia
147
When is IV magnesium replacement required?
- Mg <0.4
- Tetany
- Arrhythmias
- Seizures
148
Precipitants of lithium toxicity
- Dehydration
- Renal failure
- Drugs
149
Drugs precipitating lithium toxicity
- Diuretics, esp thiazides
- ACE inhibitors/ARBs
- NSAIDs
- Metronidazole
150
Features of lithium toxicity
- Coarse tremor
- Hyperreflexia
- Acute confusion
- Polyuria
- Seizure
- Coma
151
Management mild-moderate lithium toxicity
Volume resuscitation with normal saline, typically twice maint rate
152
Management severe lithium toxicity
Haemodialysis
153
Examples macrolides
Erythromycin
Clarithromycin
Azithromycin
154
Adverse effects macrolides
- Prolongation of QT interval
- GI effects
- Cholestatic jaundice
- P450 inhibitors
- Hearing loss and tinnitus (azithromycin)
155
Interactions macrolides
Statins - should be stopped whilst taking course of macrolides - increases risk of myopathy and rhabdomyolysis
156
Side effects spinal anaesthesia
- Hypotension
- Sensory and motor block
- Nausea
- Urinary retention
157
Relative CIs NSAIDs
- 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
Use of mefloquine
Prophylaxis and treatment of malaria
159
Advice re mefloquine
- 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
CIs mefloquine
History of psychiatric disorders
161
Use metformin
T2DM
PCOS
Non-alcoholic fatty liver disease
162
Adverse effects metformin
- GI upsets - nausea, anorexia, diarrhoea
- Reduced B12 absorption (rarely clinical problem)
- Lactic acidosis with severe liver disease or renal failure
163
Contraindications to metformin
- CKD
- Iodine-containing XR media
- Alcohol abuse (relative)
164
CKD and metformin
Review dose if Cr >130 (GFR <45)
Stop if Cr >150 (GFR <30)
165
Metformin and lactic acidosis
Can cause lactic acidosis if taken during period of tissue hypoxia - recent MI, sepsis, AKI, severe dehydration
166
Features of opioid misuse
- Rhinorrhoea
- Needle track marks
- Pinpoint pupils
- Drowsiness
- Watering eyes
- YawningCo
167
Complications opioid misuse
- Infection
- VTE
- Resp depression and death
- Psych problems - craving
- Social problems
168
Infections in opioid misuse
- Viral infections from needle sharing - HIV, hep B and C
- Bacterial infections from injection - infective endocarditis, septic arthritis, septicaemia, necrotising fasciitis
169
First line treatment opioid detoxification
Methadone or buprenorphine
170
Features organophosphate insecticide poisoning
- Salivation
- Lacrimation
- Urinary
- Defecation/diarrhoea
- Hypotension, bradycardia
- Small pupils
- Muscle fasciculation
171
Management organophosphate insecticide poisoning
Atropine
172
Management paracetamol overdose presenting within 1 hour
Activated charcoal (reduces absorption)
173
Indications for acetylcysteine in paracetamol overdose
- 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
Adverse effects acetylcysteine
Anaphylactoid reaction
175
Treatment anaphylactoid reaction to acetylcysteine
Stop infusion and restart at lower rate
176
Criteria for liver transplantation in paracetamol overdose
Arterial pH <7.3 24 hours after ingestion
Or all of;
- Prothrombin time >100
- Cr >300
- Grade III or IV encephalopathy
177
Use of PDE5 inhibitors
- Erectile dysfunction
- Pulmonary hypertension
178
Examples PDE5 inhibitors
- Sildenafil
- Tadalafil
- Vardenafil
179
Sildenafil vs tadalafil
Sildenafil short acting, taken 1 hour before sexual activity
Tadalafil long acting, may be taken on regular basis
180
Contraindications PDE5 inhibitors
- Patients taking nitrates and related drugs e.g. nicorandil
- Hypotension
- Recent stroke or MI (wait 6 months)
181
Side effects PDE5 inhibitors
- Visual disturbances - blue discolouration, non-arteritic anterior ischaemic neuropathy
- Nasal congestion
- Flushing
- GI side effects
- Headache
- Priapism
182
Types of potassium-sparing diuretics
Epithelial sodium channel blockers
Aldosterone antagonists
183
Examples epithelial sodium channel blockers
Amiloride
Triamterene
184
Examples aldosterone antagonists
Spironolactone
Eplerenone
185
Use of amiloride
Often given with thiazide or loop diuretics as alternative to potassium supplementation
186
Use of aldosterone antagonists
- Ascites
- Heart failure
- Nephrotic syndrome
- Conn's syndrome
187
Drugs exacerbating heart failure
- Thiazolidinediones
- Verapamil
- NSAIDs
- Glucocorticoids
- Class I anti-arrhythmics, e.g. flecainide
188
Drugs to avoid in renal failure
- Antibiotics - tetracycline, nitrofurantoin
- NSAIDs
- Lithium
- MetforminD
189
Drugs likely to accumulate in CKD
- Most antibiotics
- Digoxin
- Atenolol
- Methotrexate
- Sulphonylureas
- Furosemide
- Opioids
190
Drugs safe in renal failure
- Erythromycin
- Rifampicin
- Diazepam
- Warfarin
191
Antibiotics contraindicated in pregnancy
- Tetracyclines
- Aminoglycosides
- Sulphonamides
- Trimethoprim
- Quinolones
192
Other drugs contraindicated in pregnancy
- ACEi, ARBs
- Statins
- Warfarin
- Sulfonylureas
- Retinoids
- Cytotoxic agents
193
Examples quinolones
Ciprofloxacin
Levofloxacin
194
Adverse effects quinolones
- Lower seizure threshold
- Tendon damage, including rupture
- Cartilage damage
- Lengthens QT
195
Contraindications quinolones
- Pregnancy or breastfeeding
- G6PD
- Avoid in children
196
Blood gas salicylate overdose
Mixed respiratory alkalosis and metabolic acidosis
197
Features salicylate overdose
Hyperventilation
Tinnitus
Lethargy
Sweating, pyrexia
Nausea, vomiting
Hyperglycaemia, hypoglycaemia
Seizures
ComaT
198
Treatment salicylate overdose
General - ABC, charcoal
Urinary alkalisation with IV sodium bicarbonate
Haemodialysis
199
Indications for haemodialysis in salicylate overdose
- Serum conc >700mg/L
- Metabolic acidosis resistant to treatment
- Acute renal failure
- Pulmonary oedema
- Seizures
- Coma
200
SEs ACEi
Cough
Hyperkalaemia
201
SEs bendroflumethiazide
- Gout
- Hypokalaemia
- Hyponatraemia
- Impaired glucose tolerance
202
SEs calcium channel blockers
- Headache
- Flushing
- Ankle oedema
203
SEs beta blockers
- Bronchospasm
- Fatigue
- Cold peripheries
204
SEs doxazosin
Postural hypotension
205
SEs metformin
GI side effects
Lactic acidosis
206
SEs sulfonylureas
Hypoglycaemia episodes
Increased appetite and weight gain
SIADH
Liver dysfunction
207
SEs glitazones
Weight gain
Fluid retention
Liver dysfunction
Fractures
208
SEs gliptins
Pancreatitis
209
SEs St Johns Wort
- Serotonin syndrome
- P450 inducer
210
Use tamoxifen
Oestrogen receptor positive breast cancer
211
Adverse effects tamoxifen
- Menstrual disturbance - vaginal bleeding, amenorrhoea
- Hot flushes
- VTE
- Endometrial cancer
212
How long to continue tamoxifen in breast cancer
5 years following removal of tumour
213
Tamoxifen vs raloxifene
Raloxifene has lower risk of endometrial cancer
214
Teratogenic effects of ACEi
- Renal dysgenesis
- Craniofacial abnormalities
215
Teratogenic effects alcohol
- Craniofacial abnormalities
216
Teratogenic effects aminoglycosides
Ototoxicity
217
Teratogenic effects carbamazepine
- Neural tube defects
- Craniofacial abnormalities
218
Teratogenic effects chloramphenicol
'Grey baby' syndrome
219
Teratogenic effects cocaine
IUGR
Preterm labour
220
Teratogenic effects diethylstilbesterol
Vaginal clear cell adenocarcinoma
221
Teratogenic effects lithium
Ebstein's anomaly
222
Teratogenic effects maternal diabetes mellitus
Macrosomia
Neural tube defects
Polyhydraminos
Preterm labour
Caudal regression syndrome
223
Teratogenic effects smoking
Preterm labour
IUGR
224
Teratogenic effects tetracyclines
Discoloured teeth
225
Teratogenic effects valproate
Neural tube defects
Craniofacial abnormalities
226
Teratogenic effects warfarin
Craniofacial abnormalities
227
Trastuzumab aka
Herceptin
228
Use trastuzumab (herceptin)
Metastatic breast cancer
229
Adverse effects trastuzumab (herceptin)
Flu like symptoms
Diarrhoea
Cardiotoxicity
230
Early features TCA overdose
- Dry mouth
- Dilated pupils
- Agitation
- Sinus tachy
- Blurred vision
231
Features of severe TCA overdose
- Arrhythmias
- Seizures
- Metabolic acidosis
- Coma
232
ECG changes TCA overdose
- Sinus tachy
- Widening of QRS
- Prolongation of QT interval
233
Management TCA overdose
IV bicarbonate
Other drugs for arrhythmia
IV lipid emulsion
234
Indications for IV bicarbonate in TCA overdose
- Widening of QRS interval >100
- Ventricular arrhythmias
235
Anti-arrhythmics contraindicated in TCA overdose
Class 1a, e.g. quinidine, and 1c, e.g. flecainide - prolong depolarisation
Class III amiodarone - prolong QT
