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5th (Final year) > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What are the properties of the main three DOACs?

  • Mechanism
  • Excretion
  • Indications
A

Apixaban

  • Factor Xa inhibitor
  • Faecal excretion

Rivaroxaban

  • Factor Xa inhibitor
  • Liver excretion

Dabigatran

  • Thrombin inhibitor
  • Renal excretion

All are indicated for:

  • Prevention of VTE following hip/knee surgery
  • Treatment of DVT and PE
  • Prevention of stroke in non-valvular AF*

All are taken orally

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2
Q

What info do you need to include on a PRN medication ?

A

Indication and maximum frequency (max dose or BD etc.)

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3
Q

Mnemonic for enzyme (p450) inducers?

A

PC BRAS

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonylureas

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4
Q

Mnemonic for enzyme inhibitors?

A

AO DEVICES

Allopurinol
Omeprazole

Disulfiram 
Erythromycin
Valproate 
Isoniazid 
Ciprofloxacin
Ethanol
Sulphonamides
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5
Q

What should you do with prescribing long-term drugs if patient is having surgery?

A

Some need to be stopped (I LACK OP)

Most should be continued

Steroids need to be increased (and given IV)

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6
Q

What drugs need to be stopped before surgery?

A

I LACK OP

Insulin

Lithium - day before
Anticoag/platelets
COCP/HRT - 4 weeks before
K+ sparing diuretics - Day of

Oral hypoglycaemics
Perindopril (and other ACEI) - Day of

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7
Q

Mnemonic to use when looking for prescription errors?

A

PReSCRIBER

Patient details 
Reaction
Sign the front of the chart
Contraindications for each drug check
Route of each drug check
IV fluid if needed 
Blood clot prohylaxis if needed
ant-Emetic if needed
Relief from pain - prescribe if necessary
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8
Q

4 main groups of drugs that can be contraindicated?

A
  1. Drugs that increase bleeding risk should not be given to a bleeding patient, a suspected bleeding patient, or one at risk.
  2. Steroids (if showing S/Es) (STEROIDS)
    - Stomach ulcers
    - Thin skin
    - Edema
    - Right and left HF
    - Osteoporosis
    - Infection
    - Diabetes
    - Syndrome of Cushings
3. NSAIDS for NSAIDS
No urine -
Systolic dysfunction (HF)
Asthma 
Indigestion
Dyscrasia (clotting disorder)
  • (Aspirin only in Indigestion and clotting).
    4. Antihypertensives have three categories
    1. Hypotension
  1. Mechanisms
    a. Electrolyte disturbance with ACEI
    b. Bradycardia with B-blockers
  2. Specific S/Es
  • ACEI - dry cough
  • BBlockers - wheeze in asthmatics
  • Calcium channel blockers - peripheral oedema and flushing
  • Diuretics - renal failure
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9
Q

When is erythromycin most commonly contraindicated?

A

Concomitant prescription with warfarin (Enzyme inhibitor)

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10
Q

When is prophylactic heparin commonly contraindicated?

A

Acute ischaemic stroke

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11
Q

Steroid S/Es mnemonic?

A

(STEROIDS)

  • Stomach ulcers
  • Thin skin
  • Edema
  • Right and left HF
  • Osteoporosis
  • Infection
  • Diabetes
  • Syndrome of Cushings
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12
Q

NSAIDS contraindication mnemonic?

A

NSAID

No urine -
Systolic dysfunction (HF)
Asthma 
Indigestion
Disordered clotting
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13
Q

In what two situations do you prescribe fluids?

A

Replacement fluids

Maintenance fluids

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14
Q

Which fluids should you use in replacement?

A
  1. 9% saline in ALL unless:
  2. Pt is hypernatraemic or hypoglycaemic: 5% dextrose
  3. Has Ascites: Human-Albumin Solution (HAS)
  4. Is shocked, with systolic BP <90mmHg: give gelofusin (apparently)
  5. Is shocked after bleeding (give blood).
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15
Q

How much fluid should you give when giving as replacement?

A

If tachycardic/hypotensive then give 500ml bolus (250 in HF)

If only oliguric then give 1L over 2-4 hours then reassess (HR, BP and urine O/P) then change according to their response.

As a general rule don’t prescribe >2L of fluid for a sick patient

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16
Q

What fluids should you give and how much (vol) should you give in maintenance therapy?

A

General rule: Adults 3L over 24 hours, Elderly 2L.

1 salty 2 sweet: 1L 0.9% saline followed by 2L 5% Dextrose.

Potassium should be guided by U&Es. If normal then:

  • 40mmol KCL (20mmol in two bags).
  • NO MORE THAN 10mmol AN HOUR)
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17
Q

How fast should you give maintenance fluids?

A

3L a day = 8hrly bags (24hrs/3)
2L a day = 12 Hrly bags (24hrs/3)

In RL must:

  • Check U&Es
  • Check fluid status (JVP, oedema)
  • Check pts bladder is not palpable (obstruction)
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18
Q

When are compression stockings contraindicated?

A

Patient with peripheral arterial disease (PAD)

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19
Q

What antiemetic should you prescribe, and when?

A

Cyclizine in most cases (50mg) any route, apart from heart failure (worsens fluid retention)

In Heart Failure metoclopramide 10mg, however is dopamine antagonist so not in:

  • Parkinson’s disease
  • Young women (dyskinesia)
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20
Q

Pain control prescribing guidance/rules?

A

No pain
- PRN Paracetamol 1g up to 6hrly, oral

Mild Pain

  • Paracetamol 1g 6hrly, oral
  • PRN Codeine 30mg, up to 6-hrly oral

Severe pain

  • co-codamol 30/500 2 tablets 6 hrly oral
  • PRN morphine sulphate 10mg up to 6-hrly oral

Can introduce ibuprofen (400mg 8-hrly) if not contraindicated

Neuropathic pain is different (amitriptyline or pregabalin)

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21
Q

Electrolyte disturbance caused by thiazide diuretics (e.g. bendroflumethiazide)

A

Hypokalaemia

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22
Q

What main class of medications should be stopped in constipation?

A

Opiates - constipation.

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23
Q

What diuretics might cause both hypokalaemia and hyponatraemia?

A

All diuretics can cause hyponatraemia

Loop and thiazide diuretics can also cause hypokalaemia

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24
Q

Pt is on Furosemide, paracetamol, aspirin, enalapril, amlodipine and enoxaparin, pt has peripheral oedema (not caused by HF) what is the most likely culprit?

A

Amlodipine - Peripheral oedema is S/E of Ca++ channel blockers

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25
Q

What two commonly prescribed drug classes can exacerbate asthma?

A

NSAIDS, B-Blockers

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26
Q

What calcium channel antagonist can’t be used with beta blockers?

A

Verapamil

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27
Q

What route do you give insulin? When is this not so?

A

Given Subcut, apart from in sliding scales where is is IV - rapid acting

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28
Q

If a patient has asthma (but is asymptomatic) and is on ibuprofen, does it need to be stopped?

A

No it doesn’t - probably not NSAID-sensitive.

However with symptoms i.e. wheeze, then should be stopped.

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29
Q

General causes of anaemia as per their MCV?

A

Microcytic
- Iron deficiency anaemia

Normocytic anaemia

  • Anaemia of chronic disease
  • Acute blood loss

Macrocytic anaemia

  • B12/Folate deficiency
  • Excess alcohol intake/Liver disease
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30
Q

How to remember causes of hypernatraemia?

A

Begins with d Hyper-big d?

Dehydration
Drips (too much IV saline)
Drugs (with high sodium content)
Diabetes insipidus

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31
Q

Common causes of high neutrophils, low neutrophils and high lymphocytes (separately)?

A

High neutrophils

  • Bacterial infection
  • (tissue damage/steroids)

Low Neutrophils

  • Viral infection
  • Clozapine
  • Carbimazole

High lymphocytes

  • Viral infection
  • (Lymphoma/CLL)
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32
Q

Common causes of low platelets (thrombocytopenia)

A

Reduced production

  • Viral infection
  • DRUGS (penicillamine)

Increased destruction

  • Heparin
  • Hypersplenism
  • (DIC/ITP)
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33
Q

Common causes of high platelets (thrombocytosis)?

A

Reactive:

  • Tissue damage (Infection/inflammation)
  • Bleeding

Primary
- Myeloproliferative disorders

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34
Q

How do you remember the causes of SIADH?

A

SIADH

  • Small cell lung cancer
  • Infection
  • Abscess
  • Drugs (carbamazepine)
  • Head injury
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35
Q

Causes of hyponatraemia? (just the important/common ones)

A

Hypovolaemia

  • Fluid loss (vomiting/diarrhoea)
  • Diuretics

Euvolaemic
- SIADH

Hypervolaemia
- Heart, Renal and Liver failure

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36
Q

How do you remember causes of hypokalaemia?

A

DIRE

Drugs (loop and thiazide diuretics)
Inadequate intake/Intestinal losses
Renal tubular acidosis
Endocrine

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37
Q

How do you remember causes of hyperkalaemia?

A

DREAD

Drugs (K+ sparing diuretics and ACEI)
Renal failure
Endocrine (addisons)
Artefact due to clotted sample
DKA
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38
Q

What are the three different types (causes) of AKI, their respective biochemical disturbance and their causes?

A

Prerenal (70%)

  • Urea will be higher than creatinine
  • Dehydration
  • Shock
  • Renal artery stenosis

Intrarenal (intrinsic) (10%)

  • Creatinine rise much higher than urea
  • Most importantly: Nephrotixic abx, DAMN drugs

Postrenal

  • Urea rise is smaller than creatinine rise
  • Something in the Urinary tract, stone, tumour, fibrosis, BPH/prostatic cancer.
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39
Q

How do you remember the other causes of an ALP rise?

A

ALKPHOS

Any fracture
Liver damage
K for kancer
Pagets disease of bone
Hyperparathyroidism 
Osteomalacia 
Surgery
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40
Q

What is the trick to changing the dose of Levothyroxine following TFTs?

A

Use TSH as a guide - aim for 0.5-5

If <0.5 then need to decrease (Hi TSH - too much thyroid, need to reduce)

If above then need to increase (Still hypothyroid).

Change by smallest amount offered

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41
Q

LFT results in prehepatic jaundice?

A

Isolated raise in Bilirubin (Haemolysis, Gilberts)

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42
Q

LFT results in intrahepatic jaundice?

A

Bilirubin rise in addition to ALP/ALT

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43
Q

LFT results in post-hepatic jaundice?

A

Raised bilirubin and ALP (Not ALT/AST).

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44
Q

ABG interpretation routine (PSA)?

A
  1. Check FiO2 (%)
    - If on O2 and not sure about PaO2, subtract 10 from FiO2 and if PaO2 is lower then the pt is hypoxic.
  2. Check PaO2 and PaCO2
    - T1RF (Low pO2 and low/normal CO2) - Heart/Lung damage
    - T2RF (Low pO2 and high CO2) - COPD, neuromuscular failure, chest wall deformity
  3. Acid/base
    - Look at pH, then PCO2 and HCO3
    - Only CO2 abnormal = resp cause
    - Only HCO3 abnormal = metabolic cause
    - If both high or both low then there is compensation (if pH is not normal only partially compensated)
    - if they are both abnormal but in opposite directions then there is both metabolic disorder and respiratory disorder,
  4. Think about cause
    Resp alkalosis - rapid breathing

Resp acidosis - COPD, neuromuscular failure, chest wall deformity

Metabolic alkalosis - Vomiting, diuretics, conns syndrome

Metabolic acidosis - DKA, Renal failure, ethanol/methanol

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45
Q

What are the DAMNN drugs that can cause AKI?

A 
Diuretics
ACEI
Metformin
Nitrofurantoin/trimethoprim
NSAIDS
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46
Q

What are the cholinergic S/Es?

A

SLUD

Salivation
Lacrimation
Urination
Diarrhoea

(also midriasis, fasciculation, Hypotension and bradycardia)

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47
Q

Apart from the William Marrow technique what else will you see in Bundle branch block?

A

Wide QRS = >3 small squares, if they are wide check for BBB

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48
Q

Most common drugs that require monitoring?

A 
Digoxin
Theophylline
Lithium 
Phenytoin
Abx - Gent, vancomycin
Warfarin (obvs)
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49
Q

If the serum drug level is high, but the patient has serum level what should you do?

A

Still decrease the drug dose, apart from gent

If there are signs of toxicity, omit the drug for several days

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50
Q

What symptoms do you get in Digoxin Toxicity?

A

Confusion, Nausea, Visual halos, arrhythmias

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51
Q

What symptoms do you get in lithium toxicity?

A

Early: tremor
Mid: Lethargy
Late: arrhythmias, seizures, coma, renal failure

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52
Q

Phenytoin toxicity symptoms?

A

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy and teratogenicity.

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53
Q

Gentamicin toxicity symptoms?

A

Ototoxicity and nephrotoxicity

54
Q

Vancomycin toxicity symptoms?

A

Ototoxicity and nephrotoxicity

55
Q

Treatment if there is a major bleed whilst on warfarin?

A

Stop warfarin
Give 5-10mg IV Vitamin K
Give prothrombin complex

(if minor bleed give IV Vit k 1-3mg)

56
Q

What is the treatment for over-anticoagulation whilst on warfarin (depending on the INR)?

A

<6 reduce warfarin dose
6-8 omit warfarin for 2 days then reduce the dose
>8 omit warfarin and give 1-5mg oral Vit K

57
Q

When do you need bloods to monitor renal function in a patient who has just started ramipril?

A

1-2 weeks after starting

58
Q

1% equals what in terms of mg to ml?

A

1g in 100ml

59
Q

What medication do you give first in stable angina?

A

GTN

60
Q

In pregnancy what is the best anti-epileptic medication to give?

A

Lamotrigine

61
Q

If underweight or high creatinine then what medication should you avoid with diabetes?

A

Avoid metformin, give sulphonylurea

62
Q

If a phenytoin trough dose is within normal ranges is this acceptable?

A

Yes this is, the dose is suitable.

63
Q

What is the recommended sampling time for lithium levels? How often do you need to monitor?

A

12 hours after last dose.

Weekly and ofter each dose change until levels are stable, then 3 months after.

64
Q

At what level are you likely to see the toxic effects of lithium manifest?

A

> 1.5mmol/L

65
Q

Methotrexate is predominantly excreted how?

A

Renally

66
Q

Methotrexate can’t be started if pt has what abnormal tests?

A

LFTs - Hepatotoxicity

67
Q

Do you need a baseline CXR before starting methotrexate?

A

No, but it is recommended.

68
Q

For Olanzipine and other antipsychotics what tests need to be performed prior to treatment?

A

Fasting Blood Glucose in all

ECG if pt has cardiovascular disease

(also whole load of others, but not mentioned in PSA)

69
Q

What blood tests do you need before and during amiodarone therapy?

A

Full TFTs before and every 6 months

Liver function tests required before treatment and then every 6 months.

Serum potassium concentration should be measured before treatment.

Chest x-ray required before treatment.

70
Q

Sore throat when taking carbimazole may indicate…?

A

Agranulocytosis, need to check FBC

71
Q

Common antibiotics that have adverse drug reactions, and their respective reactions?

A

Gent and Vancomycin

  • Nephrotixicity
  • Ototoxicity

Cephalosporins or ciprofoxacin (any abx but these common)
- C diff

72
Q

ACEI S/Es?

A
  • Hypotension
  • Electrolyte abnormalities
  • AKI
  • Dry cough
73
Q

Beta blockers S/Es?

A
  • Hypotension
  • Bradycardia
  • Wheeze in asthmatics
  • Worsens acute HF (helps chronic HF)
74
Q

Calcium channel blockers S/Es?

A

Hypotension
Bradycardia
Peripheral oedema
Flushing

75
Q

Diuretics S/Es?

A

Hypotension
Electrolyte abnormalities
AKI

76
Q

Heparins Common S/Es?

A

Haemorrhage

Heparin induced thrombocytopenia

77
Q

Warfarin S/Es?

A

Haemorrhage

78
Q

Aspirin S/Es?

A

Haemorrhage
Peptic Ulcers
Tinnitus (large dose - ?toxicity)

79
Q

Digoxin S/Es?

A 
N&amp;V&amp;D
Blurred vision
Confusion
Drowsiness
Yellow/green vision
80
Q

Amiodarone S/Es?

A

Interstitial lung disease
Thyroid disease - both ways, similar to iodine amIODarone
Skin greying

81
Q

Lithium S/Es?

A

Early - Tremor
Mid - Tiredness
Late - Arrhythmias, seizures, coma, renal failure

82
Q

Haloperidol S/Es?

A

Dyskinesias

83
Q

Clozapine S/Es

A

Agranulocytosis

84
Q

Statins S/Es?

A

Myalgia, Abdo pain, Increased ALT/AST, Rhabdomyolysis

85
Q

When spotting drug interactions in a question what three type of drugs are normally the culprit?

A

Drugs with Narrow therapeutic index e.g. Warfarin, Digoxin, Phenytoin.

Drugs that require titration according to effect

  • Antihypertensives
  • Antidiabetic
  • If low GCS or acidotic, look for metformin

Enzyme inducers/inhibitors

86
Q

In what situation might Trimethoprim put a pt at risk of neutropenia?

A

If co-prescribed with methotrexate (due to low folate)

87
Q

At what level of paracetamol overdose do you give NAC before you have seen the paracetamol levels?

A

> 150 mg/kg

88
Q

Aspirin, ibuprofen in breast feeding?

A

Aspirin should be avoided

Ibuprofen okay.

89
Q

What are the three main drugs to avoid in asthma?

A

NSAIDS

B-blockers

Adenosine

90
Q

Digoxin monitoring following prescription for AF?

A

Ventricular rate at rest

concentration (atl 6 hours after dose) normally before next/second dose

91
Q

Drugs that interfere with seizure meds?

A 
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate
mefenamic acid
92
Q

If trough levels of gentamicin are raised what should you do?

A

Increase the interval between the doses

93
Q

What is the toxic dose of paracetamol levels (give NACT immediately)?

A

150mg per kg

so 60kg is 9000 mg

94
Q

Approximately what percentage of patients who are allergic to penicillin are also allergic to cephalosporins?

A

Around 0.5-6.5% of patients who are allergic to penicillin are also allergy to cephalosporins.

95
Q

Breakthrough pain management for oral morphine?

A

It is recommended that patients take one-sixth of their total oral morphine dose for breakthrough pain.

96
Q

What drugs reduce hypoglycaemic awareness?

A

Beta blockers

97
Q

Drugs that can cause SIADH?

A 
sulfonylureas
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide
98
Q

What diabetes meds should you start someone with CKD on?

A

Not metformin (if GFR below 30)

Gliclazide

99
Q

COPD acute exacerbation management?

A

Salbutamol, O2 (28% venturi), Ipratropium, aminophylline

100
Q

When working out breakthrough pain for opioids that aren’t morphine, what is a good method?

A

First work out what that opioid is equivalent to, then do 1/6 of the dose in morphine breakthrough/

101
Q

When prescribing for a UTI, and choosing between nitro and trimeth, what should you take into account?

A

Pregnancy and breast feeding

eGFR - Nitro should be avoided if below 45

102
Q

What is the target INR before surgery? What can you give if too hig>

A

1, if too high can give vit K (phytomenadione)

103
Q

What to look out for with the efficacy of POP medications?

A

Enzyme-inducing drugs (PC BRAS. topiramate)

104
Q

What diabetes meds should you start someone with CKD on?

A

Not metformin (if GFR below 30)

Gliclazide

105
Q

COPD acute exacerbation management?

A

Salbutamol, O2 (28% venturi), Ipratropium, aminophylline

106
Q

What drug can you withhold in iron deficiency anaemia?

A

Aspirin

107
Q

What do you monitor to evaluate the success of fluid therapy?

A

Blood pressure

108
Q

What do you monitor for adverse effects in HRT?

A

Blood pressure

109
Q

If a trough level is too high what should you do?

A

Increase the time interval between doses

110
Q

Beta blocker overdose medicine?

A

Atropine - If brady

Glucagon if atropine doesn’t work

111
Q

Drugs to give in antifreeze overdose?

A

Fomepizole

112
Q

Organophosphate poisoning overdose management?

A

Atropine

113
Q

Classic electrolyte abnormality that can precipitate digoxin toxicity?

A

Hypokalaemia

114
Q

oculogyric/dystonic crisis management?

A

Procyclidine

115
Q

Drugs to stop in PVD?

A

Vasoconstrictors, e.g. atenolol,

ACEI in severe PVD

116
Q

Drugs to stop in heart failure?

A

Steroids, Calcium channel blockers

117
Q

First and second line treatment for hypoglycaemia in hospitalised patient?

A

First is 75ml of 20% glucose

then 1mg IM glucagon

If IV access is not available then it’s glucagon first

118
Q

Best way to monitor sepsis treatment efficacy?

A

Resolution of symptoms

119
Q

Management of rhabdomyolysis in statin treatment?

A

First stop it, then restart it at a lower dose if symptoms resolve

120
Q

When do you give prothrombin in warfarin pts?

A

If there is a heavy bleed causing haemodynamic instability or into a confined space such as the skull

121
Q

What have you got to avoid in your diet if you start taking statins?

A

Grapefruit

122
Q

When should you prescribe pain relief as required and regularly?

A

If it is constant pain prescribe it regularly. Even if the pt is on the lower rung regularly if it is constant pain add the next rung regularly. Do not add co-codamol if already on paracetamol, add codeine.

123
Q

When do you dose adjust enoxaparin?

A

GFR below 30 or weighing less than 50kg

124
Q

If a pt is oliguric (but not in retention) what is the best choice of fluid prescription?

A

1 L (n saline) over 2-4hrs

125
Q

In DKA what do you do in terms of insulin management?

A

Stop short acting insulin, continue long acting and start fixed rate infusion

126
Q

In neuropathic pain, what is the first line treatment?

A

First line is always paracetamol, can go on to others, but try this first

127
Q

Screening for adverse effects of the COCP is done with what parameter?

A

Blood pressure

128
Q

In renal failure what is the best opiate to use?

A

Oxycodone

129
Q

Fluid and electrolyte requirements per kg?

A

25-30ml/kg/day of water

1mmol/kg/day for sodium, chloride and potassium

130
Q

How long do you observe patients following serious allergic reaction to a drug?

A

6-12 hours

131
Q

What are the three steps of the WHO pain ladder?

A

Step 1:
- Paracetamol (or other non opioid).

Step 2:
- weak opioid and non opioid (co-codamol)

Step 3:
- Strong opioid and non opioid

Plus adjuvants is required

5th (Final year) (34 decks)

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