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Medicine > Pharmacology Interactions and ADRs > Flashcards

Pharmacology Interactions and ADRs Flashcards

1
Q

Digoxin toxicity

A

Narrow QRS, PR interval prolongation, VT, VF

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2
Q

NSAID side effects

A

Renal failure (-> Heart failure)Reduced prostaglandin synthesis, increased gastric acid production, reduced bicarbonate, reduced mucus,

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3
Q

Antidepressant anticholinergic side effects

A 
Dry moth
Dry eyes
Dilated pupils and photosensitivity
Diplopia
Tachycardia
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4
Q

ACEI side effects

A

Cough
Hyperkalaemia
Hypotension
Renal failure (if with a diuretic and NSAID)

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5
Q

Dose dependent hepatotoxicity

A

Paracetamol

Aspirin

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6
Q

Dose independent hepatotoxicity

A 
Isoniazid
Pyrazinamide
Valproate
Methyldopa
NSAID
Phenytoin
Statin
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7
Q

Dose dependent cholestatic drugs

A

Rifampicin

Oestrogens

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8
Q

Dose independent cholestatic drugs

A 
Chlorpromazine
Clavulanic acid (Co-amox)
Cloxacillin (Fluclox)
Clarithromycin
Chlorpropamide
Carbimazole
Cimetidine
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9
Q

Micro vesicular fat deposition (Reye’s syndrome)

A

Valproate
Aspirin
Tetracyclines

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10
Q

Macro vesicular fat and cirrhosis

A

Alcohol
Amiodarone
Methotrexate

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11
Q

Rapid ADR

A

IV vancomycin can cause Red Man syndrome

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12
Q

1st Dose ADR

A

Type I hypersensitivity e.g. Penicillin allergy

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13
Q

Intermediate response ADR

A

Carbimazole or 5-ASAs can cause agranulocytosis after 3 months
Monitor for sore throat

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14
Q

Intermediate response ADR

A

Carbimazole or 5-ASAs can cause agranulocytosis after 3 months
Monitor for sore throat

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15
Q

Late response ADR

A

Corticosteroid and OP

Dopamine receptor antagonist and tardive dyskinesia

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16
Q

Delayed ADR

A

Cancer e.g. on Ciclosporin

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17
Q

Dose toxicity

A

Digoxin
Phenytoin
Theophylline
Modified release lithium

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18
Q

Concentration toxicity

A

Digoxin toxicity from renal insufficiency

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19
Q

Effect of opiate, TCA and antimuscarinics on GI motility

A

Reduced GI motility

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20
Q

Effect of metoclopramide on GI motility

A

Increased GI motility (Dopamine receptor antagonist)

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21
Q

Effect of cholestyramine on absorption of digoxin and warfarin

A

Reduced GI absorption of digoxin and warfarin

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22
Q

Effect of Antacids and milk on absorption of tetracyclines

A

Chelation of tetracycline reduces GI absorption

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23
Q

Effect of iron on prednisolone GI absorption

A

Chelation of prednisolone reduces GI absorption

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24
Q

Effects of antibiotics on warfarin absorption

A

Reduced Vit K synthesis potentiates warfarin

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25
Q

Effect of coeliac disease on digoxin absorption

A

Decreased GI absorption of digoxin

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26
Q

Effect of coeliac disease on propranolol absorption

A

Increased GI absorption of propanolol

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27
Q

Effect of coeliac disease on propranolol absorption

A

Increased GI absorption of propanolol

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28
Q

Interaction of valproate and phenytoin

A

Displacement of phenytoin from plasma protein, inhibiting metabolism

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29
Q

Interaction of ASA/NSAIDs and Methotrexate

A

Displacement of methotrexate from plasma proteins, reducing its secretion and augmenting its toxicity

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30
Q

Interaction of sulphonamides/Vitamin K/Indometacin on bilirubin

A

Displacement of bilirubin and reduced excretion in neonates causing kernicterus

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31
Q

Interaction of amiodarone and digoxin

A

Displaces digoxin from tissue binding sites, augmenting toxicity

32
Q

Interaction of amiodarone and digoxin

A

Displaces digoxin from tissue binding sites, augmenting toxicity

33
Q

Liver enzyme inducers

A 
Phenytoin
Carbamazepine
Barbiturates and BBQ food
Rifampicin
Alcohol
Smoking, St John's Wort, Sulphinpirazole
34
Q

Liver enzyme inhibitors

A 
Grapefruit juice
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Cimetidine
Ethanol
Sulphonamides
35
Q

Liver enzyme inhibitors

A 
Grapefruit juice
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Cimetidine
Ethanol
Sulphonamides
36
Q

Drugs with a narrow therapeutic index

A 
Warfarin
Anti arrhythmics
Ciclosporin
Sulphonylureas
Theophyllines
Oral contraceptive
Phenytoin
Steroids, statins
37
Q

Warfarin is displaced by

A

Salicylates
NSAIDs
Sulphonylureas

38
Q

Warfarin is potentiated by c450 inhibitors

A 
Cimetidine
Amiodarone
Acute alcohol intake
Metronidazole
Suphalyrazone
39
Q

Warfarin is inhibited by c450 inducers

A 
Phenytoin
Carbamazepine
Barbiturates/BBQ
Rifampicin
Alcohol
Smoking/St John's Wort
40
Q

Interaction of warfarin and atorvastatin

A

Atorvastatin inhibits action of Warfarin

41
Q

Interaction of warfarin and atorvastatin

A

Atorvastatin inhibits action of Warfarin

42
Q

Effect of Allopurinol on xanthine oxidase

A

Inhibition of xanthine oxidase, potentiating action of azathioprine/mercaptopurine
Risk pancytopaenia

43
Q

Effect of Carbidopa on Depa decarboxylase

A

Inhibition of dopadecarboxylase to potentiate the effects of L dopa

44
Q

Effect of Metronidazole on aldehyde dehydrogenase

A

Inhibition of aldehyde dehydrogenase, potentiating the effects of alcohol

45
Q

Effect of monoamine oxidase inhibitors

A

Potentiate the effects of amphetamines and tyramine (risk of mania)

46
Q

Cheese effect (hypertensive crisis)

A

Monoamine oxidase inhibitors and tyramine

47
Q

Effect of rifampicin on oral contraceptive

A

Oral contraceptive efficacy reduced

48
Q

Effect of omeprazole on phenytoin

A

Action of phenytoin enhanced

49
Q

Effect of Amiodarone on warfarin

A

Action of warfarin enhanced

50
Q

Effect of grapefruit juice on Ciclosporin

A

Effect of ciclosporin enhanced

51
Q

Effect of ciprofloxacin on theophylline

A

Effect of theophylline enhanced

52
Q

Effect of allopurinol on azathioprine

A

Effect of azathioprine enhanced

53
Q

Effect of Carbidopa on L dopa

A

Effect of L dopa enhanced

54
Q

Effect of probenecid on penicillin

A

Reduced active tubular secretion of penicillin, prolonging action

55
Q

Effect of nifedipine/verapamil/amiodarone on digoxin

A

Reduced active tubular secret of digoxin, potentiating its effect (MB Digoxin toxicity)

56
Q

Effect of aspirin on methotrexate

A

Reduced protein binding and reduced active tubular secretion, potentiating its effect (NB Methotrexate toxicity)

57
Q

Effect of sodium bicarbonate on aspirin

A

Reduced passive renal resorption of aspirin, reducing its effect
Use in salicylate overdose

58
Q

Effect of bendrofluazide on lithium

A

Increased passive tubular resorption of lithium, potentiating its effects

59
Q

Renal unhappy triad causing AKI

A

Beta blocker, NSAID and ACEI antagonistic effects

60
Q

Interaction of beta blocker and calcium channel blocker (verapamil, diltiazem)

A

Synergistic effect causing asystole

61
Q

Interaction of theophylline and beta agonist

A

Synergistic effect causing arrhythmia

62
Q

Interaction of loop diuretic and aminoglycoside

A

Synergistic effects increase risk of ototoxicity

63
Q

Interaction of amitryptilline and diazepam

A

Synergistic effect on sedation

64
Q

Interaction of aspirin and streptokinase/NSAID

A

Synergistic effect on anti-platelet and fibrinolysis

65
Q

Interaction of dipyridamole/theophylline/caffeine on adenosine

A

Adenosine potentiated. Reduced phosphodiesterase activity increases cAMP, reducing cellular adenosine uptake.

66
Q

Interaction of beta blocker and IV calcium channel blocker (verapamil, diltiazem)

A

Synergistic effect causing asystole

67
Q

Interaction of dipyridamole/theophylline/caffeine on adenosine

A

Adenosine potentiated. Reduced phosphodiesterase activity increases cAMP, reducing cellular adenosine uptake.

68
Q

Effect of naloxone on morphine

A

Antagonistic effect on µ-receptors with morphine

69
Q

Interaction of atenolol and salbutamol

A

Antagonistic effect on salbutamol. Can result in bronchoconstriction and bronchospasm

70
Q

Interaction of ibuprofen and bendrofluazide

A

Risk of renal toxicity due to antagonistic effects

71
Q

Interaction of furosemide and digoxin

A

Risk of hypokalaemia resulting in digoxin toxicity

72
Q

Interaction of theophylline and salbutamol

A

Risk of hypokalaemia and arrhythmia

73
Q

Interaction of furosemide and gentamycin

A

Increased risk of ototoxicity

74
Q

Interaction of aspirin and ibuprofen

A

Anti-platelet effect of aspirin is reduced

75
Q

Causes of hyperkalaemia

A 
Reduced renal clearance
Increased K+ load
Tissue breakdown
Increased release from cells
Pseudohyperkalaemia
76
Q

Management of hyperkalaemia

A

ABC, ABG, U&E and creatinine
Stop precipitating causes
IV Calcium gluconate for stabilization of cardiac membrane
Insulin and dextrose to promote K+ uptake
NaHCO3- if acidotic

Medicine (15 decks)

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