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Yr 4 - Drugs > Pharmacology - Corrections > Flashcards

Pharmacology - Corrections Flashcards

1
Q

What is the correct rate of infusion of N-acetylcysteine in a paracetamol overdose?

A

IV N-acetylcysteine over 1 hour

Acetylcysteine is a common cause of anaphylactic reactions, generally managed with slower infusions (i.e. this rate reduces risk of adverse effects).

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2
Q

What class of drug is doxazocin?

A

Alpha blocker

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3
Q

Give 2 examples of alpha blockers

A

1) tamsulosin
2) doxazosin

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4
Q

What medications may precipitate lithium toxicity?

A

1) diuretics (especially thiazides)
2) ACEi/ARBs
3) NSAIDs
4) metronidazole.

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5
Q

How can NSAIDs predispose to lithium toxicity?

A

NSAIDs can cause renal impairment by decreasing prostaglandin synthesis –> decreases in glomerular filtration rate. There is evidence that these drugs can increase lithium levels and decrease renal lithium clearance.

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6
Q

What is the appropriate dose of IM adrenaline in anaphylaxis?

A

0.5mg - 0.5ml 1:1000 IM

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7
Q

Which drugs should be AVOIDED in renal failure?

A

1) Abx: tetracycline, nitrofurantoin

2) NSAIDs

3) lithium

4) metformin

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8
Q

Which drugs are likely to accumulate in chronic kidney disease so will need dose adjustment?

A
  • most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
  • digoxin, atenolol
  • methotrexate
  • sulphonylureas
  • furosemide
  • opioids
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9
Q

Tinnitus is an early symptom of an overdose of what?

A

Salicylates e.g. aspirin

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10
Q

Who is at risk of lactic acidosis from metformin?

A

Patients with severe liver or renal failure.

Review dose in patients with eGFR <45 and STOP in <30.

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11
Q

What monitoring investigations are required in patients on amiodarone?

A

TFTs & LFTs every 6 months

CXR prior to starting treatment (but not routinely)

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12
Q

What is G6PD deficiency?

A

An X-linked recessive disorder that causes a defect in the red cell enzyme glucose-6-phosphate dehydrogenase.

This deficiency leads to intravascular haemolysis which can be triggered by the ingestion of certain drugs and foods (including fava (broad) beans).

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13
Q

What drugs are contraindicated in G6PD deficiency?

A

Drugs that can precipitate haemolysis:

  • antimalarials
  • ciprofloxaciin
  • sulphonamides (including co-trimoxazole)
  • sulphonylureas
  • sulphasalazine
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14
Q

What are quinolones?

Give 2 examples

A

A group of Abx that work by inhibiting DNA synthesis and are bactericidal in nature.

  • ciprofloxacin
  • levofloxacin
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15
Q

Adverse effects of quinolones?

A
  • lower seizure threshold in patients with epilepsy
  • tendon damage (including rupture) - the risk is increased in patients also taking steroids
  • cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children
  • lengthens QT interval
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16
Q

What are the 4 key drugs used in the management of TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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17
Q

What are the most common side effects of rifampicin?

A
  • orange bodily fluids
  • rash
  • hepatotoxicity
  • enzyme inducer (drug interactions)
  • flu like symptoms
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18
Q

What are the most common side effects of Isoniazid?

A
  • peripheral neuropathy
  • psychosis
  • hepatotoxicity
  • agranulocytosis
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19
Q

How can peripheral neuropathy as a result of isoniazid be prevented?

A

With pyridoxine (vitamin B6)

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20
Q

What are the most common side effects of pyrazinamide?

A
  • arthralgia & myalgia
  • gout (due to hyperuricaemia)
  • hepatotoxicity
  • nausea
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21
Q

What are the most common side effects of ethambutol?

A
  • optic neuritis (check visual acuity before and during treatment)
  • rash
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22
Q

If women take HRT for premature menopause, how long should it be continued for?

A

Until age of 50

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23
Q

Define premature menopause

A

Ovarian failure occurring before the age of 40.

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24
Q

What is the most important reason in giving HRT to women with premature menopause?

A

Preventing development of osteoporosis

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25
Q

Contraindications for metformin?

A

1) CKD: stop if creatinine >150 or eGFR <30

2) Can cause lactic acidosis if taken during a period where there is tissue hypoxia e.g. recent MI, sepsis, AKI and severe dehydration

3) Iodine-containing x-ray contrast media e.g. coronary angiography

4) Alcohol abuse is a relative contraindication

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26
Q

Why is metformin contraindicated in coronary angiography?

A

There is an increasing risk of provoking renal impairment due to contrast nephropathy.

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27
Q

When should metformin be stopped prior to coronary angiography?

A

On day of procedure and for 48 hours afterwards

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28
Q

What class of medication is amiloride?

A

Potassium sparing diuretic

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29
Q

Which TB medication can cause gout?

A

Pyrazinamide

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30
Q

What is the mechanism of action of unfractionated heparin?

A

Activates antithrombin III.

This in turn inhibits thrombin and factors Xa, Ixa, XIa and XIIa.

This stops fibrin formation and thrombin from activating factors V, VIII, and XI.

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31
Q

What is the treatment for adrenaline induced ischaemia?

A

Phentolamine

This drug is a competitive α-adrenoreceptor antagonist which can be injected to reverse the effects of adrenaline on the vasculature.

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32
Q

What are the features of salicylate poisoning (e.g. aspirin)?

A
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33
Q

What type of acid base disorder does salicylate poisoning lead to?

A

Leds to a mixed respiratory alkalosis and metabolic acidosis

Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis.

Note - In children metabolic acidosis tends to predominate.

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34
Q

Features of salicylate overdose?

A
  • hyperventilation (centrally stimulates respiration)
  • tinnitus
  • lethargy
  • sweating, pyrexia
  • N&V
  • hyperglycaemia and hypoglycaemia
  • seizures
  • coma
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35
Q

Treatment of salicylate overdose?

A

1) general (ABCDE, charcoal)

2) urinary alkalinisation with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine

3) haemodialysis

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36
Q

Give some indications for haemodialysis in salicylate overdose

A

1) serum concentration > 700mg/L

2) metabolic acidosis resistant to treatment

3) acute renal failure

4) pulmonary oedema

5) seizures

6) coma

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37
Q

Why should ciprofloxacin be avoided in epilepsy?

A

As ciprofloxacin lowers the seizure threshold

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38
Q

What is the key effect of organophosphate insecticide poisoning?

A

The inhibition of acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission.

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39
Q

What are the features of organophosphate poisoning the result of?

A

Accumulation of acetylcholine (due to inhibition of acetylcholinesterase).

40
Q

Give some features of organophosphate poisoning.

Mneumonic: SLUD

A

S - Salivation
L - Lacrimation
U - Urination
D - Defecation/diarrhoea

Others:
- hypotension, bradycardia
- small pupils
- fasciculations

41
Q

What is the mainstay of management of organophosphate poisoning?

A

Atropine

42
Q

Give 2 examples of tetracyclines Abx

A

1) doxycycline
2) tetracycline

43
Q

Mechanism of tetracyclines?

A

protein synthesis inhibitors

44
Q

Give 4 indications for tetracycliines?

A
  • acne vulgaris
  • Lyme disease
  • Chlamydia
  • Mycoplasma pneumoniae
45
Q

What are some notable adverse effects of tetracyclines?

A

1) discolouration of teeth (avoid in children <12)

2) photosensitivity

3) angiodema

4) black hairy tongue

Note - avoid in pregnancy & BF due to the risk of discolouration of the infant’s teeth.

46
Q

Why are tetracyclines avoided in children <12?

A

Due to risk of discolouration of teeth

47
Q

Give some causes of drug induced photosensitivity

A
  • thiazides
  • tetracyclines, sulphonamides, ciprofloxacin
  • amiodarone
  • sulphonylureas
  • NSAIDs e.g. piroxicam
48
Q

Which 3 Abx can cause photosensitivity?

A
  • tetracyclines
  • sulphonamides
  • ciprofloxacin
49
Q

What class of medication is used in the treatment of erectile dysfunction?

A

Phosphodiesterase type V (PDE5) inhibitors

50
Q

What are the 2 indications for PDE-5 inhibitors?

A

1) ED

2) Pulmonary HTN

51
Q

How do PDE-5 inhibitors work in ED?

A

Cause vasodilation through an increase in cGMP, leading to smooth muscle relaxation in blood vessels supplying the corpus cavernosum.

52
Q

What is the main example of a PDE-5 inhibitor?

A

sildenafil (Viagra)

53
Q

Give 3 contraindications of sildenafil/PDE-5 inhibitors?

A

1) patients taking nitrates and related drugs such as nicorandil

2) hypotension

3) recent stroke or MI (NICE recommend waiting 6 months)

54
Q

Give some side effects of PDE-5 inhibitors (e.g. sildenafil)?

A
  • visual disturbances e.g. blue discolouration
  • nasal congestion
  • flushing
  • GI side effects
  • priapism
  • headache
55
Q

Which drug used in the management of tuberculosis is most associated with peripheral neuropathy?

A

Isoniazid

56
Q

What are some precipitating factors for lithium toxicity

A
  • dehydration
  • renal failure
  • drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
57
Q

What are the key drugs that can cause lithium toxicity?

A
  • diuretics (especially thiazides)
  • ACEi/ARBs
  • NSAIDs
  • metronidazole
58
Q

What are some features of lithium toxicity?

A
  • coarse tremor (a fine tremor is seen in therapeutic levels)
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
59
Q

Management of lithium toxicity?

A

1) mild-moderate toxicity may respond to volume resuscitation with normal saline

2) haemodialysis may be needed in severe toxicity

60
Q

If metformin is not tolerated due to GI side-effects, what is next step?

A

try a modified-release formulation before switching to a second-line agent

61
Q

What is the most appropriate time to take blood samples for therapeutic monitoring of lithium levels?

A

12 hours after last dose

62
Q

Give some drugs that should be avoided in renal failure?

A
  • Abx: tetracycline, nitrofurantoin
  • NSAIDs
  • lithium
  • metformin
63
Q

What are the 2 main indications for HRT?

A

1) vasomotor symptoms such as flushing, insomnia and headaches

2) premature menopause

64
Q

What are the 2 routes of HRT?

A

Orally & transdermally (via a patch or gel)

65
Q

What type of HRT is preferred if the woman is at risk of VTE?

A

Transdermal HRT

66
Q

Mechanism of UH vs LMWH?

A

Heparins generally act by activating antithrombin III.

UH –> forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa

LMWH –> only increases the action of antithrombin III on factor Xa

67
Q

What are 4 key adverse effects of heparin?

A

1) bleeding
2) thrombocytopenia
3) osteoporosis & increased risk of fractures
4) hyperkalaemia

68
Q

How do heparins cause hyperkalaemia?

A

this is thought to be caused by inhibition of aldosterone secretion

69
Q

Route of administration of UH vs LMWH?

A

UH - IV

LMWH - SC

70
Q

Duration of action of UH vs LMWH?

A

UH - short

LMWH - long

71
Q

Which type of heparin has a higher risk of heparin-induced thrombocytopaenia (HIT) & osteoporosis?

A

UH

72
Q

What is heparin induced thrombocytopenia (HIT)?

A

Immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin.

This results in platelet activation and eventually thrombocytopenia.

73
Q

When does HIT typically occur?

A

5-10 days after treatment

74
Q

What is the key complication of HIT?

A

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

75
Q

Features of HIT?

A
  • 50% reduction in platelets
  • thrombosis
  • skin allergy
76
Q

What is the 1st line treatment for severe digoxin toxicity?

A

Digibind

77
Q

Features of digoxin toxicity?

A
  • generally unwell, lethargy, nausea & vomiting
  • anorexia
  • confusion
  • yellow-green vision
  • arrhythmias (e.g. AV block, bradycardia)
  • gynaecomastia
78
Q

What is the classical precipitating factor for digoxin toxicity?

A

Hypokalaemia

79
Q

How does hypokalaemia predispose to digoxin toxicity?

A

Digoxin normally binds to the ATPase pump on the same site as potassium.

Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects.

80
Q

What diuretics can cause lithium toxicity?

A

Thiazides

81
Q

Give 4 drugs that commonly cause urticaria

A

1) aspirin
2) penicillins
3) NSAIDs
4) opiates

82
Q

What is an oculogyric crisis?

A

A dystonic reaction to certain drugs or medical conditions.

It causes restlessness, agitation and involuntary upward deviation of the eyes.

83
Q

Give 3 causes of an oculogyric crisis

A

1) antipsychotics (typically 1st generation/typical)

2) metoclopramide

3) postencephalitic Parkinson’s disease

84
Q

Mainstay of management of an oculogyric crisis?

A

1) Cessation of causative medication if possible

2) IV antimuscarinic –> benztropine or procyclidine

85
Q

Which 2 TCAs are particularly dangerous in overdose?

A

Amitriptyline & dosulepin

86
Q

What are some features of TCA overdose?

A

Early –> dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision (relate to anticholinergic properties)

Features of severe poisoning include:
- arrhythmias
- seizures
- metabolic acidosis
- coma

87
Q

ECG changes in TCA overdose?

A
  • sinus tachycardia
  • widening of QRS
  • prolongation of QT interval
88
Q

How oes TCA overdose affect QT interval?

A

prolongation of QT interval

89
Q

How oes TCA overdose affect QRS complex?

A

widening of QRS

90
Q

What are the dangers of QRS widening?

A

Widening of QRS > 100ms: associated with an increased risk of seizures

QRS > 160ms: associated with ventricular arrhythmias

91
Q

What is the 1st line therapy of TCA overdose?

A

IV bicarbonate

Indications include widening of the QRS interval >100 msec or a ventricular arrhythmia.

92
Q

Mechanism of aspirin to achieve an antiplatelet effect?

A

1) irreversibly inhibits cyclooxygenase-1 (COX-1) enzyme

2) this prevents the conversion of arachidonic acid to thromboxane A2 (a potent vasoconstrictor and platelet aggregator)

93
Q

What Abx are contraindicated in pregnancy?

A
  • tetracyclines
  • aminoglycosides
  • sulphonamides and trimethoprim
  • quinolones
94
Q

Why should cyclizine be used with caution in heart failure?

A

Cyclizine is a H1-receptor antagonist that acts by blocking histamine receptors in the CTZ.

Cyclizine can cause a drop in cardiac output and an increase in heart rate. For this reason, caution should be employed in patients with severe heart failure.

95
Q

What class of drug is doxazosin?

A

Alpha blocker

96
Q

What carboxyhaemoglobin (COHb) level in smokers is normal?

A

Smokers tend to have an increased COHb level - anything up to 10% is considered normal in a smoker.

So in carbon monoxide poisoning we would expect the COHb to be at least above 10%.

97
Q
A

Yr 4 - Drugs (8 decks)

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