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Year 5 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What drugs are metabolised by the P450 system + are therefore induced/inhibited?

A
  • Warfarin
  • Statins
  • Lithium
  • Antipsychotics
  • Corticosteroids
  • COCP
  • Desogestrel
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2
Q

What drugs must be stopped before surgery?

A
  • Antiplatelets 7days (aspirin, clopidogrel), Warfarin 5days (INR at 1 for surgery)
  • Hypoglycaemics same day (gliclazide, pioglitazo), Metformin same day
  • COCP/HRT 4 wks
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3
Q

What are some common HEPATOTOXIC drugs?

A 
Statins
Amiodarone
Antipsychotics
Azathioprine
Sodium Valp

(SAAAS)

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4
Q

What are some common NEPHROTOXIC drugs?

A 
ACEi, ARBs
NSAIDs (inhibit prostaglandin synthesis in kidney, reducing cortical blood flow to kidney).
Diuretics
Tetracyclines
Gentamicin
Vancomycin
Nitrofurantoin
Metformin
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5
Q

Drugs that accumulate in renal failure?

A 
Opioids
Digoxin
Atenolol
Allopurinol
Methotrexate
Sulphonyureas
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6
Q

S/e of Steroids?

A 
NSTEROIDS (sort of)
Neutrophillia
Stomach ulcers
Thin skin
oEdema
R+L HF
Osteoporosis
Infection
Diabetes
Cushing's syndrome
Confusion (elderly)
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7
Q

What is some advice to give to a pt on steroids?

A
  • Take w/ PPI (omeprazole), or H2 antagonist (ranitidine) to reduce risk of ulcers.
  • Never stop abruptly!! = Addison’s crisis!!
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8
Q

Trimethoprim and Methotrexate are both folate antagonists, why are they C/I if given together?

A

Bone marrow suppression
Pancytopenia
Neutropenic sepsis

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9
Q

What are some important S/E of ACEi?

A 
Cough
Hyperkalaemia (monitor U&Es)
AKI
Postural hypotension (give 1st at night)
Angio-oedema
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10
Q

What are some important S/E of beta-blockers?

A 
Wheeze
Bradycardia
Hypotension
Worsens acute HF
Cold extremities
Fatigue
Sexual dysfunction
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11
Q

When are beta-blockers C/I?

A

Asthma, bradycardia, hypotension, acute HF, PAD.

Caution: can mask the effects of hypoglycaemia in diabetics!!

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12
Q

What are some important S/E of calcium-channel blockers? (Amlodipine, Verapamil)

A

Peripheral oedema
Flushing
Urinary retention

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13
Q

Why must you NOT prescribe BB and CCB together?

A

LIFE THREATENING HYPOTENSION!

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14
Q

What analgesic would you prescribe in Renal Failure?

A

Oxycodone (safer in renal failure than morphine/ fentanyl)

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15
Q

What are some important S/E of Methotrexate?

A

Leuco/Neutropenia, infections.
Hepato/pulm/GI-Toxic!!

Do NOT prescribe with Trimethoprim (another folate antagonist- as it will extrapolate effect)

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16
Q

What is some monitoring guidance and advice for pts taking Methotrexate?

A
  • WCC 1-2wkly until stable, then 2-3months.
  • LFTs baseline (do not prescribe if abnormal)
  • TERATOGENIC so contraception during treatment (+3months after) for men and women!!!
  • Give with Folic Acid (limits toxicity to bone)
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17
Q

What is an important S/E of anti-psychotics (clozapine)?

A

Agranulocytosis! (reduced Neutr/WCC).

Monitor FBC monthly!

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18
Q

What meds are C/I in breast feeding??

A 
Abx (quinolones, tetracyclines, sulphonamides)
Psych (lithium, benzos)
Aspirin (Reye's), Warfarin, Heparin
Carbimazole, MTX
Sulphonylureas
Amiodarone
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19
Q

What meds are fine in breast feeding?

A 
BB
Antiepileptics
Penicillins
Cephalosporins
Trimethoprim
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20
Q

What can increase the level of Neutrophils in the blood?

A

Bacterial infections
Steroids
Inflammation

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21
Q

What can lead to DECREASED PLATELETS?

A
  • Decreased productuon: viral infection, drugs (esp. penicillamine, a copper chelating-agent in Wilson’s disease), myeloma.
  • Increased destruction: heparin, DIC, HUS
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22
Q

How would you adjust the Levothyroxine according to T4 and TSH if:

  1. TSH <0.5
  2. TSH 0.5-5
  3. TSH >5
A

a. Decrease dose of Levo! (TSH low, too much T4 is being produced by levo)
b. Nothing (right amount of T4 being produced by levo)
c. Increase dose of Levo! (TSH high, too little T4 is being produced)

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23
Q

(common drug toxicities)

Digoxin?

A

Confusion
Nausea
Halos + yellow/green + blurred vision
Arrhythmias (ST depression, bradycardia)

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24
Q

(common drug toxicities)

Lithium?

A

Tremor (early) –> tired –> arrhythmia, seizure, coma, renal failure.

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25
Q

(common drug toxicities)

Phenytoin?

A

Gum hypertrophy
Ataxia
Nystagmus
Peripheral neuropathy

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26
Q

(common drug toxicities)

Gentamicin/Vancomycin?

A

Ototoxic + Nephrotoxic

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27
Q

Basis behind the mx of Paracetamol OD?

A

^paracetamol –> glutathione store depletes –> ^toxic NAPQI –> NAC replenishes glutathione –> protects liver.
Measure levels 4hr post…
…if above line= NAC
…if below line= :-)

28
Q

Management of an increased INR on warfarin?

a) <6
b) 6-8
c) >8
d) if active bleed

A

a) <6 = decrease dose
b) 6-8 = omit warfarin 2days + decrease dose
c) >8 = omit warfarin + Vit K PO (Phytomenadione) +/- Prothrombin complex (Beriplex)
d) if active bleed = IV VIt K + Beriplex

29
Q

How can you reverse the effect of Heparin?

A

Protamine!

30
Q

Mx for NEUTROPOENIC SEPSIS?

A

-Tazocin IV

+ Gentamicin IV

31
Q

Mx of:
Stress incontinence?
Urge incontinence?

A

Stress- Duloxetine

Urge- Oxybutynin

32
Q

What are the metabolic complications of Addisson’s? + how do you manage this if ill?

A

Hyperkalaemia + Hyponatraemia, postural drop in standing BP.

If ill: REPLACE steroids (hydrocortisone), to provide adequate cortisol to compensate for stress response.

33
Q

MoA of Anticholinergics?

A

Lock the action of ACh at synapses.
Therefore inhibits the parasympathetic NS (which usually promotes rest + digest).
So: constipation, urine retention, ^HR, blurred vision, drowsiness/confusion.

34
Q

Drugs that cause Ototoxicity? (vertigo, tinnitus, partial/profound hearing loss)

A 
Aminoglycoside Abx (gentamycin)
Macrolides (reversible!)
High dose Furosemide
Platinum-containing chemo
Quinine
35
Q

What diabetic drugs can cause a hypo? (apart from insulin)

A

Sulfonylureas!! (gliclazide)

36
Q

What diabetic drugs cause:

a) Weight gain
b) Weight loss

A

a) Sulfonylureas, Pioglitazone.

b) GLP-1-agonist (liraglutide), SGLT-2 inhibitors (empagliflozin)

37
Q

What adverse drug reactions can occur with Metformin?

A

Lactic acidosis!!!

GI effects

38
Q

What ADRs can occur with Sulfonylureas (gliclazide)?

A

SIADH

Peripheral neuropathy

39
Q

What ADRs can occur with SGLT-2-inhibitors?

A

Euglycaemic DKA
UTI
GU necrotising fasciitis

40
Q

What are some ADRs of all DMARDs ?

A
  • Predispose to severe infections
  • Hepatotoxicity
  • Mouth ulcers
41
Q

Specific ADRs of DMARDS:

a) Methotrexate?
b) Leflunomide?
c) Sulfasalazine?
d) Hydroxychloroquine?
e) Anti-TNF
f) Rituximab?

A

a) Methotrexate: pulm fibrosis.
b) Leflunomide: HTN, peripheral neuropathy.
c) Sulfasalazine: male infertility.
d) Hydroxychloroquine: nightmares, reduced visual acuity (think Trump)
e) Anti-TNF: reactivation of TB/ Hep-B!!
f) Rituximab?: night sweats, thrombocytopenia.

42
Q

ADRs of each of the 4 Anti-TB drugs:

a) Rifampicin
b) Isoniazid
c) Pyrazinamide
d) Ethambutol

A

a) Rifampicin - orange secretions, CYP450 inducer.
b) Isoniazid - Peripheral neuropathy, psychosis.
c) Pyrazinamide - Hyperuricaemia, arthralgia.
d) Ethambutol - Optic neuritis.

43
Q

How do you counteract the effect of Peripheral Neuropathy in Isoniazid?

A

Supplement with Pyridoxine!

44
Q

ADRs of Statins??

A
  • Commonly cause Rhabdomyolysis

- + also less toxic muscle pains, so give at night as will be less of a problem

45
Q

ADRs of Bisphosphonates? (interestingly)

A

Necrosis of jaw

Atypical femoral shaft fractures!

46
Q

What drugs can cause gastric ulcers?

A

NSAIDs
SSRIs
Alendronic acid

47
Q

What drugs can induce SLE? (‘drug-induced SLE’)

A

Isoniazid

Phenytoin

48
Q

What medications can cause postural hypotension?

A 
Nitrates
Diuretics
Anticholinergics
Antidepressants
Beta-blockers
L-Dopa
ACEi
49
Q

What drugs can cause Hirsutism?

A

Phenytoin

Corticosteroids

50
Q

What drugs can cause QTC prolongation?

A 
Sotalol (the only BB)
TCAs, SSRIs (esp Citalopram)
Haloperidol
Methadone
Erythromycin, Azithromycin
51
Q

What drugs are C/I in pregnancy?

A 
Atenolol
ACEi
ARBs
Aldosterone antagonists
Statins
DOACs
52
Q

What are some ADRs of Metoclopramide? (D2 receptor antagonist)

A

Extrapyramidal effects - oculogyric crisis (esp in children/young adults)
Hyperprolactinaemia
Tardive dyskinesia
Parkinsonism

53
Q

What is the risk of acutely stopping Levodopa?

A

Acute dystonia!

54
Q

What are some ADRs of the ergot-derived dopamine receptor agonists (bromocriptine, cabergoline) that are used in Parkinson’s dementia?

A

Pulmonary, retroperitoneal + cardiac fibrosis.

prior to treatment: ECHO, CXR, creatinine + ESR, and needs monitoring

55
Q

What are some ADRs of dopamine receptor agonists?

A

Impulse control disorders
Daytime somnolence
^risk hallucinations in older pts.
Nasal congestion + postural hypotension.

56
Q

What can Lithium toxicity be precipitated by?

A

Dehydration (common), renal failure, drugs (thiazide diuretics), ACEi, ARBs, NSAIDs, metronidazole.

57
Q

What is Sodium Valproate C/I in?

A

Parkinson’s (anti-DA)

WOCA / 1st tri

58
Q

What is Lamotrigine C/I in?

A

Blood disorders + bone marrow failure.

59
Q

ADRs of Carbamazepine?

A 
Headache
Blurred vision + diplopia
Dizzy + drowsy
Ataxia
Steven-Johnson's
Agranulocytosis + Neutropenia!!
60
Q

What are some ADRs of Amiodarone?

A

Hypotension (give IV bolus 300mg flushed w/20ml 0.9%NaCl)
Thryotoxicosis!! (also hypOthyroidism)
Pulmonary Fibrosis (use CT thorax to confirm changes of ILD)

61
Q

What is Mannitol indicated for? (an osmotic diuretic)

A

Cerebral oedema
^Intra-ocular pressure
Pre-eclampsia

62
Q

What are some S/E of Thiazide diuretics? (indapamide, bendroflumethiaside)

A

Exacerbates hyperglycaemia + gout
Hyponatraemia
Hypercalcaemia
Hypokalaemia

63
Q

What happens when Metronidazole is combined w/ethanol?

A

Disulfiram-like reaction (flushing, N+V, sweatiness, headache + palpitations)

64
Q

What may Isoniazid therapy cause?

A

Pellagra! (Dementia, Diarrhoea, Dermatitis)

65
Q

What can Pellagra be caused by?

A

Nicotinic acid (niacin) deficiency.
Isoniazid
Alcoholics

Year 5 (2 decks)

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