Pharmacology Flashcards
If a person has an INR of >5 but has no bleeding, what management should be implemented?
With hold 1-2 does and reduced maintenance
If a person has an INR of >5-8 and is bleeding what management should be implemented?
Stop warfarin
1-3mg of Vit K
if a person is bleeding and has an INR of >8 and is on warfarin?
Stop warfarin
5mg Vit K IV
FFP
Does metformin increase endogenous insulin?
no
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?
to avoid polypharmacy, swapping the Ca2+ to a thiazide such as:
- indapamide
What does Isoniziade do to the P450 system?
inhibits it
What are the side effects of cocaine?
M.I
Tachy/ Brady cardia
Widening QRS
aortic dissection
Seizures
Mydriasis
Hypertonia
Hyper-reflexia
Agitation
psychosis
Hyperthermia
Ulcerative colitis
Metabolic acidosis
Rhabdomyolysis
What type of drug can be used for psychotic delusions?
Dopamine antagonists
Most important toxicity implication to watch out for in gentamicin?
nephrotoxicity
ototoxicity
Macrolides should not be prescribed along side some blood pressure medications, what are these?
Amlodipine
Diltiazem
Verapamil
Tetracyclines should not be given with certain drugs, why is this?
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.
What anti-malarial is associated with psychosis?
Mefloquine
Following Tricyclic Antidepressants a patient develops widening QRS, what should be administered?
Sodium bicarbonate
Which drug can interact with levothyroxine absorption?
Iron and calcium
Name some side effects of cyclosporine:
Hypertension nephrotoxicity hepatotoxicity Gingival hyperplasia Hyperlipidaemia
Which TB drug is most associated with peripheral neuropathy?
Isoniazid
What drug is Sildenafil contraindicated with?
Nicorandil
Mechanism of action of ondansetron?
5HT3
Which antibiotics other than vancomycin also has activity MRSA?
Teicoplanin
linezolid
In soft skin infection if a person has a true penicillin allergy, what antibiotic can be used?
Doxycycline
What are the drugs that can be used in an MRSA patient?
Doxycycline
Clindamycin
Co-trimoxazole
Vancomycin
Teicoplanin
What do extended spectrum beta lactamases tend to be sensitive too?
Meropenem
What are the two metabolites of opioids?
• 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
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?
Oxycodone
- eGFR >30
- 50% of morphine
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?
Fentanyl
Fever can increase is absorption
Slow release through patch so not good for immediate acute pain
What schedule on the controlled drugs is tramadol?
Schedule 3
What stage of the WHO pain ladder is tramadol used?
Step 2
What kind of pain is tramadol useful for?
Neuropathic pain
- used 2nd line for break through pain
inflammatory pain
Alfentanil is a controlled drug, what schedule is it?
Schedule 2
How potent is Alfentanil?
1/4 the potency of fentanyl
Alfentanil can be used in a particular circumstance that a lot of other drugs can’t be, when is this?
when the eGFR is <30
In a patient with delirium who also has parkinson’s disease, what is the best pharmacological management for them?
Lorazepam
Haloperidol and other antipsychotics should be avoided in parkinson’s disease.
Who should not receive aspirin?
Asthmatics
- bronchospasm
Third trimester pregnancy
- Ductus arterioles
Peptic ulceration
Gout patient
How does clopidogrel and ticagrelor work?
ADP receptor antagonist
- inhibiting GPIIb/IIIa from forming
Why should clopidogrel not be taking with omeprazole?
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.
When should iron supplementation be stopped before a colonoscopy and why?
7 days
It can turn the stools black - making it difficult to assess the colon
When should clopidogrel be stopped before surgery?
7 days
When should allopurinol be started following a gout attack? and what drugs does it interact with?
2 weeks after the attack
azathioprine
- metabolised by xanthine oxidase
Aminotheophyline
Following paracetamol overdose, which patients are most likely to develop liver failure?
Alcoholics
Anorexia nervosa
P450 inducers
HIV
What drug is given for atypical pneumonia?
Clarithromycin
What are the main side effects of glitazones (pioglitazone)
Weight gain
fluid retention (swelling)
liver dysfunction
increased fractures
What is the dose of adrenaline given during a cardiac arrest?
10ml 1:10,000
1mg/10ml
Given IV
What is the dose of adrenaline given during an anaphylaxis shock?
- 5ml 1:1000
- 5mg
Given IM
If a person is on metformin and is acutely ill, what should you advise?
Suspend the metformin during this time
- risk of lactic acidosis
What is a major side effect of amitriptyline?
urinary retention
How is LMWH monitored and how is heparin monitored?
LMWH:
- Anti- Factor Xa
Heparin:
- APTT
Side effects of heparin:
Bleeding
Heparin induced thrombocytopenia
Osteoporosis
Hyperkalemia
Which of the DOACs may cause dyspepsia?
Dabigatran
*it is also the one not metabolised by CYP 405 enzymes
What are some symptoms of digoxin toxicity?
Bradycardia
Gastrointestinal upset
Blurring of vision
- yellow vision
Rash
- *Arrhythmias
- digoxin is a pro-arrhythmic drug
Which common blood pressure medication can cause hearing loss/ tinnitus?
Loop diuretics
What should be corrected before starting statins?
Hypothyroidism
Which drug is given as an antidote for benzodiazepine overdose?
Flumazenil
And
Activated Charcoal
What should be considered when starting people on long term steroids?
STOP
S - Sick day rules
T - Treatment card
O - osteoporosis - bisphosphonates
P - PPIs
What is the management for digoxin overdose?
Digibind
Correct arrhythmias
Monitor K+
What are some side effects of levodopa?
Dyskinesia Hypotension Hallucinations Nausea On- Off effect
Which anti-epileptic medication is PY45 inducers?
Carbamazepine
Phenytoin
What are the indicated uses for carbamazepine?
Epilepsy
Trigeminal neuralgia
Mood stabilizer
What are the indications of use for sodium valproate?
Epilepsy
Bipolar disorder
What are some important side effects of carbamazepine?
Ataxia dry mouth Diplopia Fatigue SJS**
**grapefruit can increase levels
What are some important side effects of phenytoin?
Insomnia
Rash
headache
Gingival hyperplasia
Name the 1st gen and 2nd gen antipsychotics, how do they work and what are some side effects of them?
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
When is atorvastatin used and at what dosages?
QRISK >10%: 20mg
Secondary prevention: 80mg
When should NSAIDs be avoided?
Renal failure
3rd trimester - ductus-arteriosus shuts
Peptic ulcer disease
Which drug causes red man syndrome and how is it managed?
Vancomycin
- caused by to rapid injection of the drug
Managed by:
- withhold until symptoms resolve
- restart at slower infusion
What are some important drug interactions:
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
Warfarin and cranberry juice:
Can inhibit breakdown of warfarin
- increasing INR
What should you not take with tetracyclines or fluoroquinolones?
Milk
How does aciclovir work?
Blocks RNA polymerase
Name two bisphosphonates and name some serious complications with them:
Alendronic acid
Pamidronate
Osteonecrosis of the Jaw
Atypical fractures
Dyspepsia / Stomach ulcers
*take 30 mins before food standing for 30 mins
Side effects of carbidopa:
Dyskinesia
On Off effect
Hallucinations
Nausea
Why are addison patients placed on hydrocortisone?
It has both glucocorticoid and mineralocorticoid activity
What are the side effects of corticosteroids?
Sleep disturbance Mood disturbance Weight gain Stria Hyperglycaemia Easy bruising Hypertension Supraclavicular fat Immunodeficiency
What are some important side effects of methotrexate? and what advice would you give to someone starting the drug?
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
What are the side effects of omeprazole
Headaches
Reduced defence against pathogens - C. Diff
Hypomagnesemia
- Tetany
Osteoporosis - in elderly
**avoid with clopidogrel
