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Phase 4 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

If a person has an INR of >5 but has no bleeding, what management should be implemented?

A

With hold 1-2 does and reduced maintenance

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2
Q

If a person has an INR of >5-8 and is bleeding what management should be implemented?

A

Stop warfarin

1-3mg of Vit K

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3
Q

if a person is bleeding and has an INR of >8 and is on warfarin?

A

Stop warfarin

5mg Vit K IV

FFP

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4
Q

Does metformin increase endogenous insulin?

A

no

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5
Q

If a patient is on a calcium channel blocker and is developing ankle oedema, what medication can they be switched too if the are hemodynamically stable?

A

to avoid polypharmacy, swapping the Ca2+ to a thiazide such as:
- indapamide

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6
Q

What does Isoniziade do to the P450 system?

A

inhibits it

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7
Q

What are the side effects of cocaine?

A

M.I
Tachy/ Brady cardia
Widening QRS
aortic dissection

Seizures
Mydriasis
Hypertonia
Hyper-reflexia

Agitation
psychosis

Hyperthermia

Ulcerative colitis

Metabolic acidosis
Rhabdomyolysis

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8
Q

What type of drug can be used for psychotic delusions?

A

Dopamine antagonists

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9
Q

Most important toxicity implication to watch out for in gentamicin?

A

nephrotoxicity

ototoxicity

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10
Q

Macrolides should not be prescribed along side some blood pressure medications, what are these?

A

Amlodipine
Diltiazem
Verapamil

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11
Q

Tetracyclines should not be given with certain drugs, why is this?

A

Tetracyclines are chelating agents, so will bind and prevent absorption of multiple agents.
this is very important when a patient is on:
- Ferrous fumarate or other irons
as they will bind together and neither will be absorbed.

it is also why tetracyclines should be avoided with milk or other Ca2+ containing foods.

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12
Q

What anti-malarial is associated with psychosis?

A

Mefloquine

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13
Q

Following Tricyclic Antidepressants a patient develops widening QRS, what should be administered?

A

Sodium bicarbonate

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14
Q

Which drug can interact with levothyroxine absorption?

A

Iron and calcium

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15
Q

Name some side effects of cyclosporine:

A 
Hypertension 
nephrotoxicity 
hepatotoxicity 
Gingival hyperplasia 
Hyperlipidaemia
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16
Q

Which TB drug is most associated with peripheral neuropathy?

A

Isoniazid

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17
Q

What drug is Sildenafil contraindicated with?

A

Nicorandil

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18
Q

Mechanism of action of ondansetron?

A

5HT3

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19
Q

Which antibiotics other than vancomycin also has activity MRSA?

A

Teicoplanin

linezolid

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20
Q

In soft skin infection if a person has a true penicillin allergy, what antibiotic can be used?

A

Doxycycline

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21
Q

What are the drugs that can be used in an MRSA patient?

A

Doxycycline

Clindamycin

Co-trimoxazole

Vancomycin

Teicoplanin

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22
Q

What do extended spectrum beta lactamases tend to be sensitive too?

A

Meropenem

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23
Q

What are the two metabolites of opioids?

A

• Morphine-3- glucuronide/ M3G
- This may be inactive or antagonise the effect of morphine

• Morphine -6-glucuronide/ M6G  This may actually be more active than morphine
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24
Q

Which opioid is preferred when there is CKD? what dose should it be administered at in comparison to morphine and what is the recommended eGFR?

A

Oxycodone

  • eGFR >30
  • 50% of morphine
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25
Q

Which Opioid can be given as a transdermal patch? What can lead to an increase in its absorption? and what is it not good for?

A

Fentanyl

Fever can increase is absorption

Slow release through patch so not good for immediate acute pain

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26
Q

What schedule on the controlled drugs is tramadol?

A

Schedule 3

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27
Q

What stage of the WHO pain ladder is tramadol used?

A

Step 2

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28
Q

What kind of pain is tramadol useful for?

A

Neuropathic pain
- used 2nd line for break through pain

inflammatory pain

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29
Q

Alfentanil is a controlled drug, what schedule is it?

A

Schedule 2

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30
Q

How potent is Alfentanil?

A

1/4 the potency of fentanyl

31
Q

Alfentanil can be used in a particular circumstance that a lot of other drugs can’t be, when is this?

A

when the eGFR is <30

32
Q

In a patient with delirium who also has parkinson’s disease, what is the best pharmacological management for them?

A

Lorazepam

Haloperidol and other antipsychotics should be avoided in parkinson’s disease.

33
Q

Who should not receive aspirin?

A

Asthmatics
- bronchospasm

Third trimester pregnancy
- Ductus arterioles

Peptic ulceration

Gout patient

34
Q

How does clopidogrel and ticagrelor work?

A

ADP receptor antagonist

- inhibiting GPIIb/IIIa from forming

35
Q

Why should clopidogrel not be taking with omeprazole?

A

Clopidogrel is a pro-drug activated by P450 enzymes.

Omeprazole is an inhibitor - thus should not be used in combination as the therapeutic effects of clopidogrel will be lost.
Lansoprazole is preferred.

36
Q

When should iron supplementation be stopped before a colonoscopy and why?

A

7 days

It can turn the stools black - making it difficult to assess the colon

37
Q

When should clopidogrel be stopped before surgery?

A

7 days

38
Q

When should allopurinol be started following a gout attack? and what drugs does it interact with?

A

2 weeks after the attack

azathioprine
- metabolised by xanthine oxidase

Aminotheophyline

39
Q

Following paracetamol overdose, which patients are most likely to develop liver failure?

A

Alcoholics

Anorexia nervosa

P450 inducers

HIV

40
Q

What drug is given for atypical pneumonia?

A

Clarithromycin

41
Q

What are the main side effects of glitazones (pioglitazone)

A

Weight gain
fluid retention (swelling)
liver dysfunction
increased fractures

42
Q

What is the dose of adrenaline given during a cardiac arrest?

A

10ml 1:10,000

1mg/10ml

Given IV

43
Q

What is the dose of adrenaline given during an anaphylaxis shock?

A
  1. 5ml 1:1000
  2. 5mg

Given IM

44
Q

If a person is on metformin and is acutely ill, what should you advise?

A

Suspend the metformin during this time

- risk of lactic acidosis

45
Q

What is a major side effect of amitriptyline?

A

urinary retention

46
Q

How is LMWH monitored and how is heparin monitored?

A

LMWH:
- Anti- Factor Xa

Heparin:
- APTT

47
Q

Side effects of heparin:

A

Bleeding
Heparin induced thrombocytopenia
Osteoporosis
Hyperkalemia

48
Q

Which of the DOACs may cause dyspepsia?

A

Dabigatran

*it is also the one not metabolised by CYP 405 enzymes

49
Q

What are some symptoms of digoxin toxicity?

A

Bradycardia

Gastrointestinal upset

Blurring of vision
- yellow vision

Rash

  • *Arrhythmias
  • digoxin is a pro-arrhythmic drug
50
Q

Which common blood pressure medication can cause hearing loss/ tinnitus?

A

Loop diuretics

51
Q

What should be corrected before starting statins?

A

Hypothyroidism

52
Q

Which drug is given as an antidote for benzodiazepine overdose?

A

Flumazenil

And

Activated Charcoal

53
Q

What should be considered when starting people on long term steroids?

A

STOP

S - Sick day rules
T - Treatment card
O - osteoporosis - bisphosphonates
P - PPIs

54
Q

What is the management for digoxin overdose?

A

Digibind
Correct arrhythmias
Monitor K+

55
Q

What are some side effects of levodopa?

A 
Dyskinesia 
Hypotension 
Hallucinations 
Nausea 
On- Off effect
56
Q

Which anti-epileptic medication is PY45 inducers?

A

Carbamazepine

Phenytoin

57
Q

What are the indicated uses for carbamazepine?

A

Epilepsy
Trigeminal neuralgia
Mood stabilizer

58
Q

What are the indications of use for sodium valproate?

A

Epilepsy

Bipolar disorder

59
Q

What are some important side effects of carbamazepine?

A 
Ataxia 
dry mouth 
Diplopia 
Fatigue 
SJS**

**grapefruit can increase levels

60
Q

What are some important side effects of phenytoin?

A

Insomnia
Rash
headache
Gingival hyperplasia

61
Q

Name the 1st gen and 2nd gen antipsychotics, how do they work and what are some side effects of them?

A

1st line: Haloperidol and Chlorpromazine

2nd line: Olanzapine and Clozapine

Dopamine Antagonists (D2 receptors)- mesolimbic and nigrostriatal

Side effects:

  • extrapyramidal movement abnormalities
  • acute dystonic reactions
  • Sedation
  • postural hypotension
  • Hypoprolactinaemia
  • QT prolongation

**contraindicated in Parkinson’s disease

62
Q

When is atorvastatin used and at what dosages?

A

QRISK >10%: 20mg

Secondary prevention: 80mg

63
Q

When should NSAIDs be avoided?

A

Renal failure
3rd trimester - ductus-arteriosus shuts
Peptic ulcer disease

64
Q

Which drug causes red man syndrome and how is it managed?

A

Vancomycin
- caused by to rapid injection of the drug

Managed by:

  • withhold until symptoms resolve
  • restart at slower infusion
65
Q

What are some important drug interactions:

A

Metformin and cimetidine
- inhibits renal clearance

Gentamicin and loop diuretics
- prevents clearance

ACE inhibitors and K+ sparing
- Hyperkalemia

Statins and macrolides

Thiazides and PPI
- hyponatremia

Thiazide and lithium
- toxicity

66
Q

Warfarin and cranberry juice:

A

Can inhibit breakdown of warfarin

- increasing INR

67
Q

What should you not take with tetracyclines or fluoroquinolones?

A

Milk

68
Q

How does aciclovir work?

A

Blocks RNA polymerase

69
Q

Name two bisphosphonates and name some serious complications with them:

A

Alendronic acid
Pamidronate

Osteonecrosis of the Jaw
Atypical fractures
Dyspepsia / Stomach ulcers

*take 30 mins before food standing for 30 mins

70
Q

Side effects of carbidopa:

A

Dyskinesia

On Off effect

Hallucinations

Nausea

71
Q

Why are addison patients placed on hydrocortisone?

A

It has both glucocorticoid and mineralocorticoid activity

72
Q

What are the side effects of corticosteroids?

A 
Sleep disturbance 
Mood disturbance 
Weight gain 
Stria 
Hyperglycaemia 
Easy bruising 
Hypertension 
Supraclavicular fat 
Immunodeficiency
73
Q

What are some important side effects of methotrexate? and what advice would you give to someone starting the drug?

A

Bone marrow suppression
Mucosal damage
Pulmonary fibrosis
Hepatic cirrhosis

To be taken once a week

If they develop:
- sore throat (immunosuppression)
- jaundice
they should seek medical attention

Contraception

Folic acid supplements

74
Q

What are the side effects of omeprazole

A

Headaches

Reduced defence against pathogens - C. Diff

Hypomagnesemia
- Tetany

Osteoporosis - in elderly

**avoid with clopidogrel

Phase 4 (49 decks)

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