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Medicine - Finals > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Side effect of Penicillin.

On examination, there are widespread erythematous bullae and vesicles covering almost half the body surface. Lesions are also present on the oral mucosa and beginning to affect the eyes. Nikolsky’s sign is positive.

A

Toxic epidermal necrolysis is a rare but important side effect of which to be aware of penicillins

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2
Q

What bloods should be done before starting TB treatment?

A

LFTs

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3
Q

Rifampicin. Mechanism of action? Side effects?

A

mechanism of action: inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA

potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms

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4
Q

Isoniazid. Mechanism of action? Side effects?

A

mechanism of action: inhibits mycolic acid synthesis

peripheral neuropathy: prevent with pyridoxine (Vitamin B6) hepatitis, agranulocytosis
liver enzyme inhibitor

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5
Q

Pyrazinamide. Mechanism of action? Side effects?

A

mechanism of action: converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I

hyperuricaemia causing gout
arthralgia, myalgia
hepatitis

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6
Q

Ethambutol. Mechanism of action? Side effects?

A

mechanism of action: inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan

optic neuritis: check visual acuity before and during treatment
dose needs adjusting in patients with renal impairment

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7
Q

Heparin reversal

A

Protamine sulfate

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8
Q

What is Heparin-induced Thrombocytopaenia?

A

Immune mediated (Anti-PF4) - antibodies bind to the PF4-heparin complexes on the platelet surface and induce platelet activation

Develop after 5-10 days of treatment

Despite being associated with low platelets HIT is actually a prothrombotic condition

Features include a greater than 50% reduction in platelets, thrombosis and skin allergy

Address need for ongoing anticoagulation:
direct thrombin inhibitor e.g. argatroban
danaparoid

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9
Q

Worrying side effect with Amiodarone

A

Pulmonary Fibrosis

Others: thyroid disturbances (Amiodarone can cause thyroid dysfunction due to its high iodine content and direct toxic effect on the thyroid); a slate-grey appearance of the skin; and further arrhythmias.

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10
Q

Which supplements can interfere with levothyroxine treatment?

A

Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart

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11
Q

Which antibiotic causes torsades de pointes?

A

Macrolides e.g., Clarithromycin

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12
Q

When is metformin contraindicated?

A

eGFR <30

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13
Q

Which biochemical derangements are caused by PPIs?

A

Hyponatraemia and Hypomagnesiumia

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14
Q

Which NSAID is contraindicated in all forms of CV disease?

A

Diclofenac

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15
Q

Main side effect of Colchicine

A

Diarrhoea

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16
Q

Which vitamin is supplemented in patients with parkinson’s?

A

D

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17
Q

Antifreeze or Ethylene glycol toxicity management

A

Fomepizole.

Also ethanol / haemodialysis

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18
Q

Benzodiazepines toxicity management

A

Flumazenil

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19
Q

Paracetamol overdose management

A

N-acetylcysteine

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20
Q

Management of carbon monoxide poisoning.

A

Hyperbaric oxygen

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21
Q

Management of essential tremor

A

Propanolol

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22
Q

St John’s-wort affect on liver enzymes

A

Inducer of P450

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23
Q

Drugs that cause galactorrhoea

A

Metoclopramide, Domperidone
Phenothiazines (e.g. Chlorpromazine)
Haloperidol

Very rare: SSRIs, Opioids

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24
Q

What type of antibiotic may cause rhabdomyolysis in patients on a statin?

A

Macrolides e.g. Clarithromycin

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25
Q

Ciclosporin side effects

A

Remember everything is increased

Side-effects:

  • hypervolaemia
  • hypertension
  • hyperkalaemia
  • hair growth
  • gum hypertrophy
  • hyperglycaemia
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26
Q

Reaction. Azathioprine and Allopurinol

A

Increase risk of azathioprine toxicity causing neutropenic sepsis

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27
Q

Statins and liver impairment

A

2014 NICE guidelines recommend checking LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

Transient increases in LFTs are to be expected

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28
Q

P450 inhibitors

A
  • Antibiotics: ciprofloxacin, erythromycin, isoniazid, quinupristin
  • H2R blocker: cimetidine
  • PPI: omeprazole
  • Amiodarone
  • Allopurinol
  • Imidazoles: ketoconazole, fluconazole
  • SSRIs: fluoxetine, sertraline
  • Ritonavir
  • Sodium valproate
  • Acute alcohol intake
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29
Q

P450 inducers

A 
Antiepileptics: phenytoin, carbamazepine
Barbiturates: phenobarbitone
Rifampicin
St John's Wort
Chronic alcoholism
Griseofulvin
Smoking (affects CYP1A2, reason why smokers require more aminophylline)
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30
Q

Causes of drug-induced peptic ulcer

A

NSAIDs
SSRIs
Corticosteroids
Bisphosphonates

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31
Q

Drug causes of acute urinary retention

A

Remember DONAT

Disopyramide
Opioids
NSAIDs
Anticholinergics
TCAs e.g. amitriptyline
32
Q

Causes of LQTS and Torsades de Pointes

A 
Causes of long QT interval
congenital: Jervell-Lange-Nielsen syndrome, Romano-Ward syndrome
antiarrhythmics: amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants
antipsychotics
chloroquine
terfenadine
erythromycin
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
myocarditis
hypothermia
subarachnoid haemorrhage
33
Q

Arrhythmia risks associated with SSRIs particularly Citalopram

A

QT prolongation and Torsades de pointes

34
Q

Side effects of glucocorticoids

A

endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia

Cushing’s syndrome: moon face, buffalo hump, striae

musculoskeletal: osteoporosis, proximal myopathy,
avascular necrosis of the femoral head

immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
psychiatric: insomnia, mania, depression, psychosis
gastrointestinal: peptic ulceration, acute pancreatitis
ophthalmic: glaucoma, cataracts

suppression of growth in children

intracranial hypertension

neutrophilia

35
Q

Side effects of mineralocorticoids

A

fluid retention

hypertension

36
Q

Which drugs can precipitate digoxin toxicity?

A

Thiazides

37
Q

Management of digoxin toxicity

A

1 - Digibind
+ correct arrhythmias
+ monitor potassium

38
Q

Side effects of SSRIs

A

GI upset + bleeding (give PPI)
Hyponatraemia

Citalopram -> QT prolongation

interaction with warfarin / heparin - consider changing to Mirtazapine; also with triptans

39
Q

What is the mechanism of action of sitagliptin?

A

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1

40
Q

What medication causes Hyaline casts seen on urine microscopy?

A

Loop diuretics

41
Q

Verapamil Side Effects

A 
Heart block if co-prescribed with B-blocker
Heart Failure
Constipation
Hypotension
Bradycardia
Flushing
42
Q

Drugs causing lower zone lung fibrosis

A

drug-induced: amiodarone, bleomycin, methotrexate

43
Q

LSD intoxication

A

Benzodiazepines

44
Q

Paracetamol overdose

A

activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation

45
Q

Salicyclate overdose

A

urinary alkalinization with IV bicarbonate

haemodialysis

46
Q

Benzodiazepine overdose

A

Flumazenil

47
Q

Tricyclic overdose

A

IV bicarbonate
+ lignocaine if arrhythmia still present after pH stabilised
Dialysis if severe

48
Q

Beta-blocker overdose

A

if bradycardic then atropine

in resistant cases glucagon may be used

49
Q

Ethylene glycol overdose

A

Fomepizole

Ethanol (used to be first line)

50
Q

Organophosphate insecticides overdose

A

Atropine

51
Q

Iron overdose

A

Desferrioxamine, a chelating agent

52
Q

Lead overdose

A

Dimercaprol, calcium edetate

53
Q

Cyanide overdose

A

Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

54
Q

Which antiemetic drugs possess significant dopaminergic antagonist activity and is associated with involuntary arm movements?

A

Chlorpromazine, Promethazine, Metclopramide

55
Q

Which anti-hypertensive causes impotence?

A

Thiazide diuretics e.g. Indapamide

56
Q

Which anti-hypertensives can worsen glucose tolerance?

A

Thiazide diuretics e.g. Indapamide

57
Q

Side Effects of Diltiazem

A 
CCB 
Smaller risk of Heart Block with B-blockers (compared with Verapamil)
Hypotension
Bradycardia 
Heart Failure
Ankle Swelling
58
Q

Which CCB type does not effect cardiac muscle as much and so is better in Heart Failure?

A

Dihydrpyridines

  • Nifedipine
  • Amlodipine
59
Q

Which CCB is the most negatively inotropic?

A

Verapamil

60
Q

Side Effects of Dihydropyridines

A

Very high risk of ankle swelling due to effect on vascular smooth muscle
Flushing
Headache

61
Q

Monitoring with ACEI

A

U+E before and after starting ACEI and after increasing doses
acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l.

62
Q

ACEI first-line for hypertension in…

A

<55

diabetics

63
Q

Main dose-limiting side effect of Oral Magnesium Salts

A

Diarrhoea

64
Q

Side effects of Tetracyclines

A 
discolouration of teeth: therefore should not be used in children < 12 years of age
photosensitivity
angioedema
black hairy tongue
Idiopathic Intracranial Hypertension
65
Q

Which antibiotic can cause idiopathic intracranial hypertension?

A

Tetracycline e.g. Doxycycline

COCP

66
Q

Which drugs exacerbate plaque psoriasis?

A

aspirin

beta blockers

67
Q

Vancomycin - adverse effects

A

nephrotoxicity
ototoxicity
thrombophlebitis
red man syndrome; occurs on rapid infusion of vancomycin

68
Q

Which type of diuretic causes impotence?

A

Thiazide

69
Q

Which type of diuretic causes impaired glucose tolerance?

A

Thiazides (Loops to a lesser extent)

70
Q

Which type of diuretic causes ototoxicity?

A

Loop

71
Q

Side effects of beta-blockers

A 
bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction
72
Q

Contraindications of beta-blockers

A

uncontrolled heart failure
asthma
sick sinus syndrome
concurrent verapamil use: may precipitate severe bradycardia

73
Q

Management of beta-blocker overdose

A

if bradycardic then atropine

in resistant cases glucagon may be used

74
Q

Features of organophosphate insecticide poisoning

A

Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)

Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation

Remember everything relaxes - therefore treatment involves atropine (anticholinergic)

75
Q

What factors increase risk of paracetamol overdose?

A

high risk if chronic alcohol, HIV, anorexia or P450 inducers

76
Q

Lithium Toxicity + Treatment

A 
Coarse tremor 
Hyperreflexia 
Acute confusion
Polyuria
Seizures

mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity

Medicine - Finals (21 decks)

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