Pharmacology and Toxicology

Question 1

Rifampicin
- how does it effect cytochrome system
- effect on protease inhibitors

Answer 1

Enzyme inducer = greater metabolism
Less protease inhibitor, may see worsening of HIV control

Question 2

Factors increasing transdermal opiate absorption

Answer 2

Heat
- pyrexial patients may get opiate toxic

Question 3

Management of methanol poisoning

Answer 3

Fomepizole

Question 4

Oral morphine > fentanyl patch conversion

Answer 4

5: 2
i.e. 45mg total daily morphine = 18mg fentanyl 24H patch

Question 5

Contra-indications to BB

Answer 5

Asthma
2nd Degree HB
Concurrent use with non-dihydropyridine CCB (e.g. diltiazem, verapamil)

Question 6

Hallucinations
Seizure
Mycolonus
Mydriasis
HTN
Hypokalaemia
AKI
- diagnosis?

Answer 6

Synthetic cannabinoid toxicity

Question 7

Modification of gentamicin
- pre dose concentration high
- post dose concentration

Answer 7

Pre dose high = increase interval between doses

Post dose high = decrease dose

Question 8

Side effect associated with azathioprine and ——

Answer 8

Marrow suppression
Allopurinol

Question 9

Tryptase in anaphylaxis

Answer 9

Normal at presentation
Elevates at 1-2 hours (defo by 4 hours)

Question 10

Vitamin D loading =

Answer 10

<30 mmol

Question 11

Cause of erythema multiforme

Answer 11

Allopurinol

Question 12

Raised anion gap
Disparity between calculated and measured osmolality

Answer 12

Ethylene glycol poisoning
- there is an additional unaccounted for solute

Question 13

Analgesia with NMDA antagonism

Answer 13

Methadone

Question 14

Management of CO poisoning
- pregnant

Answer 14

Hyperbaric oxygen

Question 15

Malignant hyperthermia
- mechanism
- management

Answer 15

Excess calcium release: rigidity then hyperthermia
IV dantrolene - prevents Ca2+ release from sarcoplasmic reticulum

Question 16

MDMA intoxication
- presentation
- management

Answer 16

Serotonin syndrome and rhabdomyolysis
Mx: IV benzodiazepines
Cyprohepatidine - reverses the serotonin syndrome

Question 17

Management of lead poisoning

Answer 17

DMSA for chelation of lead

Question 18

Toxicity
- seizure + QTC prolongation
- what do you need to avoid?

Answer 18

e.g. fluoxetine
Need to avoid phenytoin - also works via sodium inhibition, can worse cardiotoxicity effects and cause deterioration into TdP

Question 19

What medications are licensed for 2y prevention?

Answer 19

Only statins

Question 20

Side effects of levetiracetam (2)

Answer 20

Behaviour abnormalities
Psychosis

Question 21

Mixed overdose involving benzodiazepines

Answer 21

Don’t use flumenazil
Largely supportive airway management

Question 22

House fire
Lactic acidosis
Not septic
Normal PO2
Comatose
Bradycardia
- diagnosis?
- management

Answer 22

Cyanide poisoning
Mx: sodium thiosulphate

Question 23

What liver injury pattern does
- nitrofurantoin
- co-amoxiclav
cause?

Answer 23

Hepatitic picture = nitrofurantoin, normal ALP
Cholestatic = Co-amoxiclav

Question 24

Feature of carbamazepine

Answer 24

= autoinduction
Levels drop 3-4 weeks in and if not appropriately uptitrated, seizures will return

Question 25

Side effect of NRTI
- presentation (4)

Answer 25

= mitochondrial toxicity
Nausea
Pancreatitis
Lactic acidosis
Lipoatrophy

Question 26

Prophylaxis for surgery in hereditary angiooedema

Answer 26

TXA

Question 27

Cause of seizure in withdrawal (assuming pabrinex and chlordiazepoxide used)

Answer 27

Hypophosphataemia

Question 28

Drug-induced pemphigoid (3)

Answer 28

Furosemide
Captopril
Penicillins