Pharmacology and Toxicology Flashcards by Miranda King

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

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

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Factors increasing transdermal opiate absorption

Heat
- pyrexial patients may get opiate toxic

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Management of methanol poisoning

Fomepizole

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Oral morphine > fentanyl patch conversion

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

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Contra-indications to BB

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

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Hallucinations
Seizure
Mycolonus
Mydriasis
HTN
Hypokalaemia
AKI
- diagnosis?

Synthetic cannabinoid toxicity

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

Pre dose high = increase interval between doses

Post dose high = decrease dose

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Side effect associated with azathioprine and ——

Marrow suppression
Allopurinol

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Tryptase in anaphylaxis

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

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Vitamin D loading =

<30 mmol

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Cause of erythema multiforme

Allopurinol

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Raised anion gap
Disparity between calculated and measured osmolality

Ethylene glycol poisoning
- there is an additional unaccounted for solute

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Analgesia with NMDA antagonism

Methadone

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Management of CO poisoning
- pregnant

Hyperbaric oxygen

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Malignant hyperthermia
- mechanism
- management

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

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MDMA intoxication
- presentation
- management

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

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Management of lead poisoning

DMSA for chelation of lead

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

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

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What medications are licensed for 2y prevention?

Only statins

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Side effects of levetiracetam (2)

Behaviour abnormalities
Psychosis

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Mixed overdose involving benzodiazepines

Don’t use flumenazil
Largely supportive airway management

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

Cyanide poisoning
Mx: sodium thiosulphate

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

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

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Feature of carbamazepine

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

Side effect of NRTI - presentation (4)

= mitochondrial toxicity Nausea Pancreatitis Lactic acidosis Lipoatrophy

Prophylaxis for surgery in hereditary angiooedema

TXA

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

Hypophosphataemia

Drug-induced pemphigoid (3)

Furosemide Captopril Penicillins

Reversal of dabigatran

Idarucizumab

Side effect of trimethoprim

Hyperkalaemia = has distal sodium tubule action, promotes sodium loss at expense of potassium

Drug action nicorandil Contra-indications for nicorandil

= Partial nitrate action, partial ATP K+ dependent opening CI = concurrent use with sildenafil, hypotension

2nd line in HTN management - eGFR <30

Loop diuretic e.g. furosemide

What drug used in TB is associated with visual loss? Pattern of visual loss?

Ethambutol Optic neuropathy - see central scotoma

Side effect of ethambutol

Gradual onset bilateral visual loss

Monitoring for cabergolin

Need annual echo - associated with valvulopathy

What effect does smoking have on enzymes?

Enzyme inducer = higher rates of metabolism, higher concentrations of drugs needed

3rd line management of HTN

Thiazide-LIKE diuretics e.g. indapamide

When would you screen for 2y causes of HTN?

<40 years old Resistant hypertension Other signs or symptoms consistent with 2y HTN causes

Side effect of nitrofurantoin

Peripheral neuropathy

What can hypomagnesaemia cause?

2y hypoparathyroidism

Abstinence - drug used to reduce cravings - drug used to unpleasant effect

Acamprosate Disulfiram

What drug is associated with lithium toxicity?

NSAIDs = result in reduced excretion in kidney disease

Chronic lithium toxicity - how do you know? - what do you do?

= renal dysfunction: shouldn't be any dysfunction in acute toxicity If levels >2.5 then dialysis

Linezolid + SSRI - diagnosis?

Serotonin syndrome

Management of serotonin syndrome

Cyprohepatidine

Rigidity Increased HR HTN Hyperpyrexia - diagnosis?

Serotonin syndrome

What can interfere with AEDs to worsen seizure control?

Mefanamic acid

What anti-emetic can cause diarrhoea?

Metoclopramide

When should you start statin following CVA?

48 hours afterwards

RUQ post partum Acute hepatitis - cause?

Labetalol used for gestational HTN can cause acute hepatitis

Drug mechanism of denusomab

RANKL inhibitor

Management of hereditary angioedema

FFP or C1 inhibitor concentrate

Adujvant in methanol poisoning

Folinic acid - reduces ophthalmological complications

What TB medication is associated with peripheral neuropathy

Isoniazid

Side effect of pyrazinamide

Arthralgia

What is a trough level? What is a peak level?

Trough = pre dose level If high then increase interval time of doses Peak = post dose level If high then decrease dose

Side effect of efavirenz

Neurotoxic e.g. psychotic symptoms

Management of hiccups (4)

Chlorpromazine Haloperidol Metoclopramide Dexamethasone

Management of CO poisoning

High flow oxygen UNTIL - patient asymptomatic - <10% CO levels