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Parker FRCEM Primary > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What are the 2 most common electrolyte disturbances seen with thiazide diuretics?

A

Hyponatraemia

Hypokalaemia

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2
Q

Which drugs should not be given in combination with Verapamil due to negative inotropic effect?

A

Beta blockers

Quinidine

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3
Q

What is the mechanism of action of Ketamine?

A

non-competitive antagonism of the NMDA receptor Ca2+ channel pore

also inhibits NMDA receptor activity by interaction with the phenylcyclidine binding site

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4
Q

Co-administration of what type of drug can help reduce incidence of psychotic effects from ketamine?

A

Benzodiazepines

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5
Q

What are the 5 ECG changes seen in TCA overdose?

A 
Sinus tachy
Prolonged PR interval
Broad QRS
Prolonged QT
Ventricular arrhythmias
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6
Q

Give 3 examples of antibiotics that interfere with cell wall synthesis?

A

Penicillins
Cephalosporins
Vancomycin

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7
Q

What is the leading cause of drug-induced angioedema in UK?

A

ACEi

Patients most commonly present with swelling of the lips, tongue, or face, although another presentation is episodic abdominal pain due to intestinal angioedema. Urticaria and itching are notably absent.

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8
Q

What are the 4 clotting factors inhibited by Warfarin?

What other 3 factors are also inhibited?

A

VIt K dependent clotting factors - 2, 7, 9, 10.

Protein C, Protein S, Protein Z

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9
Q

What are the antidotes for sulfonylurea poisoning?

A

Glucose

Octreotide

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10
Q

What dose of Amiodarone is used in VF/pVT arrest and how is it prepared?

A

300mg IV after 3rd shock

Diluted in 5% dextrose to volume of 20ml

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11
Q

What drug can be given in VF/pVT arrest if Amiodarone is unavailable?

A

Lidocaine, 1 mg/kg

do not give lidocaine if amiodarone has already been given.

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12
Q

What drug can be used to treat acute drug induced dystonic reactions?

A

Procyclidine - an anticholinergic

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13
Q

What is the mechanism of action of Enoxaparin?

A

Enoxaparin is a low molecular weight heparin (LMWH) that binds to and potentiates the inhibitory effect of antithrombin III in a similar manner to heparin. Antithrombin III forms a 1:1 complex with thrombin and inactivates it. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting.

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14
Q

What drugs can be used in thyroid storm to block the release of thyroid hormones?

A

Potassium iodide

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15
Q

Why should Furosemide and SSRIs such as Citalopram not be prescribed together?

A

Increased risk of hyponatraemia and hypokalaemia, potentially increasing risk of Torsades de pointes

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16
Q

What is the MOA of thiazide diuretics?

A

Acts on NaCl co-transporter in DCT

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17
Q

What is the MOA of loop diuretics?

A

Acts on NaK2Cl co-transporter in ascending loop of Henle

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18
Q

What is the MOA of Adenosine?

A

Opens K+ channels in heart, slowing conduction in the AV node

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19
Q

What is the MOA of Amiodarone?

A

Blocks Na+ and K+ channels and beta-adrenoreceptors, prolonging phase 3 of cardiac action potential and slowing conduction at SA and AV nodes

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20
Q

What is the MOA of Verapamil?

A

Blocks Ca2+ channels in heart, slowing conduction in the AV node

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21
Q

Which anti-epileptic medication is most closely linked to cleft palate?

A

Phenytoin

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22
Q

What is a 1% solution?

A

1g per 100ml

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23
Q

What is the maximal safe dose of plain lidocaine?

A

3 mg/kg

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24
Q

When should Lidocaine not be used with Adrenaline?

A

In fingers, toes and nose (extremities) due to risk of vasoconstriction and tissue necrosis

Although lidocaine alone tends to cause vasodilation

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25
Q

What is the duration of lidocaine and half life?

A

Half life 1.5-2 hours

Duration of action when used alone is 30-60 mins

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26
Q

What is thought to be the MOA of paracetamol?

A

Paracetamol is thought to work by selectively inhibiting cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord. COX-3 is responsible for the production of prostaglandins in these areas, which sensitizes free nerve endings to the chemical mediators of pain.

Therefore by selectively inhibiting COX-3 paracetamol effectively reduces pain sensation.

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27
Q

What is the MOA of Aspirin?

A

Aspirin irreversibly blocks cyclo-oygenase by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2

At low doses (75 mg per day) aspirin only inhibits COX-1, the enzyme responsible for making thromboxane A2, and therefore principally exhibits an anti-thrombotic effect.

At medium to high doses (500-5000 mg per day) aspirin inhibits both COX-1 and COX-2. COX-2 is responsible for the production of prostaglandins and therefore has an anti-inflammatory effect at these doses.

28
Q

How does Propofol effect cardiac output?

A

Propofol produces a 15-25% decrease in blood pressure and systemic vascular resistance without a compensatory increase in heart rate. It is negatively inotropic and decreases cardiac output by approximately 20%.

29
Q

List P450 enzyme inducers?

PC BRASS

A 
P – Phenytoin
C – Carbemazepine.
B – Barbiturates
R – Rifampicin
A – Alcohol (chronic ingestion)
S – Sulphonylureas
S – Smoking

St John’s Wort

30
Q

List P450 enzyme inhibitors?

MOCK DEVICES

A

M - Metronidazole
O – Omeprazole
C - Chloramphenicol
K - Ketoconazole

D – Disulfiram
E – Erythromycin (And other macrolide antibiotics)
V – Valproate (sodium valproate)
I – Isoniazid
C – Ciprofloxacin
E – Ethanol (acute ingestion)
S – Sulphonamides
31
Q

Give 1 example of an antiemetic that works via antimuscarinic effect?

A

Hyoscine

32
Q

Give 3 examples of antiemetics that work via antihistamine effect?

A

Cyclizine
Promethazine
Cinnarizine

33
Q

Give 3 examples of antiemetics that work via anti dopamine effect?

A

Domperidone
Metoclopramide
Prochlorperazine

34
Q

Give 2 examples of antiemetics that work via 5-HT3 receptor antagonism?

A

Ondansetron

Granisetron

35
Q

Grey baby syndrome is caused by which antibiotic?

A

Chloramphenicol

36
Q

What is the normal QTc interval?

A

< 440 ms

The QTc interval is considered to be borderline if it is >440 ms but <500 ms.

A prolonged QTc interval >500 ms is clinically significant

37
Q

What is the MOA of most TCAs?

What type of side effects do they tend to cause?

What type of drugs should not be used alongside TCAs?

A

SNRI effects
Examples include - Amitriptyline, Imipramine

Antimuscarinic side effects

Avoid using with monoamine oxidase inhibitors (MAOIs), such as selegiline, and should be started at least 2 weeks after stopping the MAOI. There is a risk of developing serotonin toxicity.

38
Q

What are the similarities and differences between first and second generation antipsychotics?

Give some examples?

A

First-generation (conventional or typical) antipsychotics, are strong dopamine D2 antagonists. However, each drug in this class has various effects on other receptors, such as serotonin type 2 (5-HT2), alpha1, histaminic, and muscarinic receptors.

First-generation antipsychotics have a high rate of extrapyramidal side effects, including rigidity, bradykinesia, dystonias, tremor, and akathisia. Tardive dyskinesia, which is involuntary movements in the face and extremities, is another adverse effect that can occur with first-generation antipsychotics. Neuroleptic malignant syndrome (NMS) can also occur with these agents.

Second-generation (novel or atypical) antipsychotics, with the exception of aripiprazole, are dopamine D2 antagonists, but are associated with lower rates of extrapyramidal adverse effects and TD than the first-generation antipsychotics. However, they have higher rates of metabolic adverse effects and weight gain.

1st generation:
Chlopromazine
Haloperidol
Fluphenazine
Trifluoperazine
2nd generation:
Clozapine
Olanzapine
Quetiapine
Risperidone
Aripiprazole
39
Q

Which class of Abx is administered during pregnancy can cause the child to have permanently yellow stained teeth and increased risk of dental cavities?

A

Tetracyclines

Children are susceptible to tetracycline related tooth staining until around age 8.

40
Q

What is the recommended dose of Dexamethasone for Croup as per APLS guidelines?

A

150 mcg/kg

Max single dose 12 mg

41
Q

What dose of IV/IO Adrenaline is used in paediatric cardiac arrest?

A

10 mcg/kg

42
Q

What is the intubating dose of Atracurium?

A

The ‘intubating’ dose of atracurium is 0.3-0.6 mg/kg and subsequent doses are one-third of this amount. Satisfactory intubating conditions are produced within 90 seconds of administration.

43
Q

How long after starting an IV Aminophylline infusion should a level be taken?

A

4-6 hours

44
Q

List 6 drugs that can cause Stevens-Johnson syndrome and toxic epidermal necrolysis?

A 
Tetracyclines
Penicillins
Vancomycin
Sulphonamides
NSAIDs
Barbiturates

In Stevens-Johnson syndrome epidermal detachment is seen in less than 10% of the body surface area, whereas in toxic epidermal necrolysis epidermal detachment is seen in greater than 30% of the body surface area.

45
Q

What dose of Flumazenil should be given IV in benzodiazepine overdose?

When should Flumazenil be avoided?

A

200 ug every 1-2 mins
Max dose 3 mg/hour

Flumazenil should be avoided if the patient dependant on benzodiazepine or takes tricyclic antidepressants as it can precipitate a withdrawal syndrome in these patients. In these circumstances it can cause seizures or cardiac arrest.

46
Q

Give 3 indications for checking the INR in a child with possible Warfarin overdose?

A

Delayed presentation (>6 hours)
Patients with symptoms or signs of anticoagulation
Possible massive ingestion

Clotting studies including an INR are often organised routinely but small children who have ingested warfarin do not require INRs or follow up if they have been treated with 10 mg vitamin K. This dose of vitamin will completely reverse the anticoagulative effects of warfarin.

47
Q

What effect can SSRIs such as fluoxetine and sertraline have on the newborn if started during the 3rd trimester?

A

Persistent pulmonary hypertension

48
Q

How does Lidocaine act as an antiarrhythmic?

A

Blocks sodium channels in the heart.

This raises the depolarization threshold and makes the heart less likely to initiate or conduct early action potentials that may cause an arrhythmia.

49
Q

What is the mechanism of action of Adenosine?

A

Opens K+ channels in heart, slowing conduction in the AV node

50
Q

What may happen if Warfarin is given during the first trimester of pregnancy?

A

Fetal warfarin syndrome - nasal hypoplasia, bone stippling, bilateral optic atrophy, intellectual disability.

51
Q

What biochemical abnormalities do you expect to see in theophylline overdose?

A 
Hypokalaemia
Hypomagnasaemia
Hypophosphataemia
Hyper or hypocalcaemia
Hyperglycaemia
52
Q

What is deficient in hereditary angioedema?

What can be given as prophylaxis?

What is the usual inheritance pattern?

How is it treated acutely?

A

C1 esterase inhibitor

Tranexamic acid can be given prophylaxis

Usually autosomal dominant

Angioedema and anaphylaxis due to C1 esterase inhibitor deficiency is resistant to adrenaline, steroids and antihistamines and needs treatment with C1 esterase inhibitor concentrate or fresh frozen plasma, which contains C1 esterase inhibitor.

Short-term prophylaxis for situations that may precipitate an attack can be achieved with C1 esterase inhibitor or fresh frozen plasma infusions prior to the event.

Long-term prophylaxis can be achieved with androgenic steroids such as stanozolol or antifibrinolytic drugs such as tranexamic acid.

53
Q

What class of antibiotics should be avoided with Furosemide?

A

Macrolide Abx due to increased risk of hypokalaemia and therefore torsades de pointes

54
Q

What are the side effects of Entonox?

A

N&V
Dizziness
Euphoria
Inhibition of Vitamin B12 synthesis

55
Q

What dose of nebulised Budesonide is used for children aged 1 month to 18 years for croup?

A

2mg

May be repeated 12 hourly

56
Q

How do NSAIDs cause renal adverse drug reactions?

A

Prostaglandins normally cause dilation of afferent arteriole

NSAIDs reduce prostaglandin levels

Therefore reduced renal plasma flow and GFR, but no effect on filtration fraction

57
Q

What is the therapeutic range for Lithium?

A

0.4-0.8 mmol/l

Levels should be checked one week after starting therapy and one week after every change in dosage.

58
Q

What is the MOA of Abciximab?

A

Abciximab (ReoPro) is a chimeric monoclonal antibody that is a glycoprotein IIb/IIIa receptor antagonist.

It inhibits platelet aggregation and is mainly used during and after coronary artery procedures such as angioplasty.

59
Q

What antibiotics are used for post-exposure chemoprophylaxis for whooping cough if indicated?

A

Macrolide Abx

60
Q

What effect does St John’s wort have on plasma theophylline concentration?

A

St John’s wort decreases plasma concentration of theophylline

61
Q

Give 2 examples of Abx classes that increase plasma concentration of theophylline?

A

Macrolides - eg. Erythromycin

Quinolones e.g. Ciprofloxacin

62
Q

What dose of IV adenosine is used in SVT?

A

6mg, then 12mg, then 12mg, at 1-2 minute intervals

Patients with a heart transplant, however, are very sensitive to the effects of adenosine and should receive a reduced initial dose of 3mg, followed by 6 mg and then 12 mg.

63
Q

Summarise the 3 areas of effect of CCB overdose such as Verapamil?

A

Cardiac effects:
Negative inotropic
Negative Chronotropic
Negative dromotropic

Vasc smooth muscle tone effects:
Reduced afterload
Systemic hypotension
Coronary vasodilation

Metabolic effects:
Hypoinsulinaemia: insulin release is dependent on calcium influx into islet beta cells through L-type calcium channels
Calcium channel blocker-induced insulin resistance

64
Q

What is Entonox a mix of?

A

50/50 mix of O2 and Nitrous Oxide (N2O)

65
Q

Give examples of the different generations of Cephalosporin?

A

1st - Cefalexin, cefradine and cefadroxil

2nd - Cefuroxime

3rd - Cefotaxime, ceftazidime and ceftriaxone

66
Q

Which drugs are known to undergo enterohepatic circulation?

MAD EARTOP

A

M - Morphine, methadone and metronidazole
A - Amphetamine
D - Vitamin D

E - Erythromycin
A - Ampicillin
R - Rifampicin
T - Tetracyclines
O - OCP
P - Phenolphthalein
67
Q

List drugs causing a prolonged QT interval?

A 
Antimicrobials
Erythromycin
Clarithromycin
Ciproflaxacin
Moxifloxacin
Fluconazole
Ketoconazole
Antiarrhythmics
Procainamide
Sotalol
Quinidine
Amiodarone
Flecainide
Antipsychotics (all have some risk)
Risperidone
Haloperidol
Chlorpromazine
Quetiapine
Clozapine
Antidepressants
Citalopram
Fluoxetine
Amitriptyline
Clomipramine
Dosulepin
Doxepin
Imipramine
Lofepramine
Antiemetics
Domperidone
Droperidol
Ondansetron
Granisetron
Others
Methadone
Hydroxychloroquine
Chloroquine
Quinine
Some antiretrovirals
Loratadine

Parker FRCEM Primary (6 decks)

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