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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
Ciclosporin side effects
Remember everything is increased Side-effects: - hypervolaemia - hypertension - hyperkalaemia - hair growth - gum hypertrophy - hyperglycaemia
26
Reaction. Azathioprine and Allopurinol
Increase risk of azathioprine toxicity causing neutropenic sepsis
27
Statins and liver impairment
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
28
P450 inhibitors
- Antibiotics: ciprofloxacin, erythromycin, isoniazid, quinupristin - H2R blocker: cimetidine - PPI: omeprazole - Amiodarone - Allopurinol - Imidazoles: ketoconazole, fluconazole - SSRIs: fluoxetine, sertraline - Ritonavir - Sodium valproate - Acute alcohol intake
29
P450 inducers
``` Antiepileptics: phenytoin, carbamazepine Barbiturates: phenobarbitone Rifampicin St John's Wort Chronic alcoholism Griseofulvin Smoking (affects CYP1A2, reason why smokers require more aminophylline) ```
30
Causes of drug-induced peptic ulcer
NSAIDs SSRIs Corticosteroids Bisphosphonates
31
Drug causes of acute urinary retention
Remember DONAT ``` Disopyramide Opioids NSAIDs Anticholinergics TCAs e.g. amitriptyline ```
32
Causes of LQTS and Torsades de Pointes
``` 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
Arrhythmia risks associated with SSRIs particularly Citalopram
QT prolongation and Torsades de pointes
34
Side effects of glucocorticoids
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
Side effects of mineralocorticoids
fluid retention | hypertension
36
Which drugs can precipitate digoxin toxicity?
Thiazides
37
Management of digoxin toxicity
1 - Digibind + correct arrhythmias + monitor potassium
38
Side effects of SSRIs
GI upset + bleeding (give PPI) Hyponatraemia Citalopram -> QT prolongation interaction with warfarin / heparin - consider changing to Mirtazapine; also with triptans
39
What is the mechanism of action of sitagliptin?
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
40
What medication causes Hyaline casts seen on urine microscopy?
Loop diuretics
41
Verapamil Side Effects
``` Heart block if co-prescribed with B-blocker Heart Failure Constipation Hypotension Bradycardia Flushing ```
42
Drugs causing lower zone lung fibrosis
drug-induced: amiodarone, bleomycin, methotrexate
43
LSD intoxication
Benzodiazepines
44
Paracetamol overdose
activated charcoal if ingested < 1 hour ago N-acetylcysteine (NAC) liver transplantation
45
Salicyclate overdose
urinary alkalinization with IV bicarbonate | haemodialysis
46
Benzodiazepine overdose
Flumazenil
47
Tricyclic overdose
IV bicarbonate + lignocaine if arrhythmia still present after pH stabilised Dialysis if severe
48
Beta-blocker overdose
if bradycardic then atropine | in resistant cases glucagon may be used
49
Ethylene glycol overdose
Fomepizole | Ethanol (used to be first line)
50
Organophosphate insecticides overdose
Atropine
51
Iron overdose
Desferrioxamine, a chelating agent
52
Lead overdose
Dimercaprol, calcium edetate
53
Cyanide overdose
Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
54
Which antiemetic drugs possess significant dopaminergic antagonist activity and is associated with involuntary arm movements?
Chlorpromazine, Promethazine, Metclopramide
55
Which anti-hypertensive causes impotence?
Thiazide diuretics e.g. Indapamide
56
Which anti-hypertensives can worsen glucose tolerance?
Thiazide diuretics e.g. Indapamide
57
Side Effects of Diltiazem
``` CCB Smaller risk of Heart Block with B-blockers (compared with Verapamil) Hypotension Bradycardia Heart Failure Ankle Swelling ```
58
Which CCB type does not effect cardiac muscle as much and so is better in Heart Failure?
Dihydrpyridines - Nifedipine - Amlodipine
59
Which CCB is the most negatively inotropic?
Verapamil
60
Side Effects of Dihydropyridines
Very high risk of ankle swelling due to effect on vascular smooth muscle Flushing Headache
61
Monitoring with ACEI
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
ACEI first-line for hypertension in...
<55 | diabetics
63
Main dose-limiting side effect of Oral Magnesium Salts
Diarrhoea
64
Side effects of Tetracyclines
``` discolouration of teeth: therefore should not be used in children < 12 years of age photosensitivity angioedema black hairy tongue Idiopathic Intracranial Hypertension ```
65
Which antibiotic can cause idiopathic intracranial hypertension?
Tetracycline e.g. Doxycycline | COCP
66
Which drugs exacerbate plaque psoriasis?
aspirin | beta blockers
67
Vancomycin - adverse effects
nephrotoxicity ototoxicity thrombophlebitis red man syndrome; occurs on rapid infusion of vancomycin
68
Which type of diuretic causes impotence?
Thiazide
69
Which type of diuretic causes impaired glucose tolerance?
Thiazides (Loops to a lesser extent)
70
Which type of diuretic causes ototoxicity?
Loop
71
Side effects of beta-blockers
``` bronchospasm cold peripheries fatigue sleep disturbances, including nightmares erectile dysfunction ```
72
Contraindications of beta-blockers
uncontrolled heart failure asthma sick sinus syndrome concurrent verapamil use: may precipitate severe bradycardia
73
Management of beta-blocker overdose
if bradycardic then atropine | in resistant cases glucagon may be used
74
Features of organophosphate insecticide poisoning
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
What factors increase risk of paracetamol overdose?
high risk if chronic alcohol, HIV, anorexia or P450 inducers
76
Lithium Toxicity + Treatment
``` 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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