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MSRA > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the adverse effect of long term nitrofurantoin use and how does this present/appear on imaging?

A

Pulmonary fibrosis. Alveolar infiltrates on CXR affecting both upper and lower lobes.

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2
Q

Which antidepressant has the shortest half life?

A

Venlafaxine (SNRI) - half life of 4-7 hours. Therefore more likely to cause withdrawal symptoms, and so is weaned over months.

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3
Q

Which antidepressant has the longest half life?

A

Fluoxetine. 4-6 days. More dangerous in overdose and needs to be cross-tapered very slowly.

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4
Q

How long is citalopram’s half life?

A

Around 36 hours

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5
Q

How long is mirtazapine’s half life?

A

20-40 hours

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6
Q

How long is sertraline’s half life?

A

22-36 hours

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7
Q

What are the features of clozapine toxicity?

A

Drowsiness, hyperthermia, confusion, hypersalivation and seizures

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8
Q

Which antipsychotic carries a risk of agranulocytosis?

A

Clozapine

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9
Q

What are the indication and adverse effects of melatonin in children?

A

Only licensed for insomina in autism. Adverse effects are odd dreams, headaches, arthralgia and altered behaviour.

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10
Q

What advice do you give when switching from norethisterone to COCP?

A

7 day period of condom use required

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11
Q

What advice to give when switching from desogestrel to COCP?

A

No additional contraceptive required

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12
Q

Which contraceptive is linked to liver pathology? And which liver pathologies are associated?

A

Oestrogen containing ones. Small increased risk of cholestasis, adenoma, gallstones and HCC. They are contraindicated in those with existing HCC.

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13
Q

What is the contraindication for yellow fever vaccine?

A

Anaphylactic egg allergy

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14
Q

What is mefloquine used for and what are its adverse effects?

A

Anti-malarial. Associated with neuropsychiatric effects - abnormal dreams, insomnia, A+D, suicidal ideation and psychosis. CI in those with GAD, depression and epilepsy.

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15
Q

Which antibiotic is and antifolate and therefore should not be used with methotrexate?

A

Trimethoprim. Can cause bone marrow suppression when used together.

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16
Q

What is topiramate used for? And what are cautions to be aware of?

A

Migraine prophylaxis and epilepsy. Reduces efficacy of contraceptives and increases risk of cleft lip and palate. IUD should be used in those of child bearing age.

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17
Q

What are some dose considerations with mirtazapine?

A

At lower dose (15mg) it acts on histaminergic receptors, causing tirednesss. At higher dose this effect is lost, and it only acts on serotoninergic and noradrenergic receptors.

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18
Q

What are adverse effects of macrolide antibiotics?

A

QT prolongation, GI effects and cholestatic jaundice. They are P450 inhibitors and so statins should be held.

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19
Q

Cautions and contraindications with diclofenac?

A

MHRA warning regarding CV events with diclofenac. Absolutely contraindicated with hypertension, diabetes and hypercholesterolaemia. Iburprofen and naproxen are safer and as effective.

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20
Q

What are the adverse effects of furosemide?

A

Ototoxicity, nephrotoxicity (including acute interstitial nephritis)

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21
Q

Adverse effect of aspirin?

A

Ototoxicity

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22
Q

Which drugs can cause drug-induced lupus?

A

Chlorpromazine, methyldopa, hydralazine, isoniazid, D-penicillamine and minocycline.

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23
Q

Which drugs cause drug induced psoriasis?

A

Beta blockers, ACEi, lithium, HCQ, NSAIDs and amoxicillin.

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24
Q

What is bromocriptine and what are its adverse effects?

A

Ergot-derived dopamine receptor agonist. Associated with pulmonary, retroperitoneal and pericardial fibrosis. Baseline echo, ESR, Cr and CXR are recommended before commencing.

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25
Q

Which antidepressants are contraindicated with tamoxifen and why?

A

Fluoxetine, paroxetine and bupropion. These are potent inhibitors of CYP26D, which is needed to metabolise tamoxifen into its active form. Sertraline is a weak inhibitor and is considered safe.

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26
Q

Which drugs can cause pancreatitis?

A

Mesalazine, benzafibrate, carbimazole, codeine, enalapril, isoniazid, metronidazole, statins, procainamide, sulfas, tetracyclines.

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27
Q

What are the adverse effects and contraindications with pioglitazone?

A

Increases risk of bladder cancer - therefore to be avoided in those who smoke, the elderly and those who have had previous pelvic irradiation. Contraindicated in those with IHD. Should monitor LFTs while taking

28
Q

What are the adverse effects of methadone?

A

“Clouding”, constipation, drowsiness, muscular aches

29
Q

Tell me about the MoA and pharmacokinetics of methadone

A

Full opiate receptor agonist with unpredictable kinetics - can have a half life of 13 to 112 hours

30
Q

What is the MoA of buprenorphine?

A

Partial opiate agonist but also with some antagonist actions

31
Q

How do you transition from methadone to buprenorphine?

A

Withdraw methadone, wait for withdrawal symptoms to start and then introduce buprenorphine.

32
Q

What is the reversal agent for salicylates?

A

IV bicarb/dialysis

33
Q

What is the reversal agent for benzos?

A

Flumezanil

34
Q

What is the reversal agent for TCAs?

35
Q

What is the reversal agent for lithium?

A

Fluids and dialysis

36
Q

What is the reversal agent for heparin?

37
Q

What is the reversal agent for beta blockers?

A

Atropine and glucagon

38
Q

What is the reversal agent for ethylene glycol and methanol?

A

Fomepizole or ethanol

39
Q

What is the reversal agent for organophosphates?

40
Q

What is the reversal agent for iron?

A

Desferrioxamine

41
Q

What is the reversal agent for lead?

A

Dimercaprol, calcium ederate

42
Q

What is the reversal agent for cyanide?

A

Hydroxocobalamin

43
Q

What are the features of organophosphate toxicity?

A

Think SLUD. Salivation, lacrimation, urination, defaecation/diarrhoea. CV effects of bradycardia and hypotension. Can sometimes see fasciculations.

44
Q

What are the adverse effects of methotrexate?

A

Myelosuppression, mucositis, cirrhosis, pneumonitis

45
Q

What are the adverse effects of sulfasalazine?

A

Rashes, oligospermia, Heinz body anaemia and ILD

46
Q

What are the adverse effects of leflunomide?

A

Liver impairment, ILD, hypertension

47
Q

What are the adverse effects of HCQ?

A

retinopathy/corneal deposits

48
Q

What are the adverse effects of Gold for RA?

A

Proteinuria

49
Q

What are the adverse effects of penicillamines?

A

Proteinuria/nephrotic syndrome, myasthenia exacerbation

50
Q

What are the adverse effects of etanercept?

A

TB reactivation and demyelination

51
Q

What are the adverse effects of adalimumab?

A

TB reactivation

52
Q

Which antibiotic can cause thrombocytopaenia?

53
Q

What are the adverse effects of acarbose?

A

Flatulence and diarrhoea

54
Q

Which drug used for TB treatment can cause optic neuritis?

A

Ethambutol

55
Q

What is the MoA and adverse effect of cyclophosphamide?

A

MoA: Alkylating agent, causing DNA crosslinking
AE: haemorrhagic cystitis, myelosuppression and TCC

56
Q

What is the MoA and adverse effect of bleomycin?

A

MoA: Antibiotic which degrades DNA
AE: Lung fibrosis

57
Q

What is the MoA and adverse effect of anthracyclines (doxorubicin)?

A

MoA: Stabilises DNA-topoisomerase II complex, inhibiting RNA and DNA synthesis
AE: Cardiomyopathy

58
Q

What is the MoA and adverse effect of 5-FU?

A

MoA: Pyrimidine analogue, cause cell cycle arrest
AE: Myelosuppression, mucositis, dermatitis

59
Q

What is the MoA and adverse effect of 6-mercaptopurine?

A

MoA: Purine analogue
AE: Myelosuppression

60
Q

What is the MoA and adverse effect of cyarabine?

A

MoA: Pyrmidine antagonist, inhibits DNA and polymerase synthesis
AE: Myelosuppression, ataxia

61
Q

What is the MoA and adverse effect of vincristine/vinblastine?

A

MoA: Inhibits formation of microtubules
AE: Peripheral neuropathy, paralytic ileus, myelosuppression

62
Q

What is the MoA and adverse effect of docetaxel?

A

MoA: Decreases free tubulin
AE: Neutropaenia

63
Q

What is the MoA and adverse effect of irinotecan?

A

MoA: Inhibits topoisomerase
AE: Myelosuppression

64
Q

What is the MoA and adverse effect of cisplatin?

A

MoA: Causes DNA crosslinking
AE: Nephrotoxicity, ototoxicity, peripheral neuropathy, hypomagnasaemia

65
Q

What antiepileptic is commonly associated with weight gain?

66
Q

Which antiemetic is used second line in pregnancy and why?

A

Ondansetron. Increases risk of cleft lip and palate, therefore consider risk vs benefit

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