Pharmacology on passmed yr 5

Question 1

what is the difference between a fine tremour and a coarse tremor and when is it seen with lithium use

Answer 1

Tremors are often described by their amplitude, or how wide the movement is, and their frequency, or how fast the shaking is. A fine tremor has a low amplitude and is barely noticeable, while a coarse tremor has a high amplitude and large displacement

chronic lithium use in fine tremour
lithium toxicity acutely - coarse

Question 2

what is a coarse intention tremor

Answer 2

coarse intention tremor (worse with goal-directed movements) of a slow frequency.

seen in cerebellar stroke

Question 3

what things might precipitate lithium toxicity

Answer 3

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

Question 4

some other features of lithium toxicity

Answer 4

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

Question 5

monitoring repsonse to dalteparin what factor do you measure

Answer 5

10a

Question 6

in renal failure what heparin in better

Answer 6

unfractionated - so would need to monitor APTT

Question 7

adrenaline doses in anaphylaxis and cardiac arrest

Answer 7

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

Question 8

gingerval hyperplasia - overgrowth of gums caused by what 3 medications

Answer 8

phenytoin, cyclosporine, or calcium channel blockers.

Question 9

drug or medical causes of low magnesium

Answer 9

diuretics
proton pump inhibitors
total parenteral nutrition

Question 10

tx of low magnesium depending on value

Answer 10

<0.4 mmol/L or tetany, arrhythmias, or seizures
intravenous magnesium replacement is commonly given.
an example regime would be 40 mmol of magnesium sulphate over 24 hours

> 0.4 mmol/l
oral magnesium salts (10-20 mmol orally per day in divided doses)
diarrhoea can occur with oral magnesium salts

Question 11

statins need to monitor

Answer 11

LFT

Creatine kinase levels do not need to be routinely monitored unless there is a suspicion of myopathy

Question 12

Azathioprine monitoring

Answer 12

FBC lFT

Question 13

amiodarone drug monitoring

Answer 13

TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months

Question 14

warfarin stopped how long before surgery

Answer 14

Warfarin is usually stopped 5 days pre-operatively

Question 15

in renal failure or disease for treating VTW why is using unfractionated heparin better than LMWH

Answer 15

Bleeding is significantly more common with LMWH than with Unfractionated Heparin (UFH) among patients with severe renal impairment

because it has a shorter half-life and is easier to reverse:

Question 16

drugs used for motion sickness

Answer 16

Motion sickness - hyoscine(patch) > cyclizine > promethazine

Question 17

corneal opacities side effect of what drug

Answer 17

amiodarone
indomethacin

Question 18

what drug can cause optic neuritis

Answer 18

ethambutol
amiodarone
metronidazole

Question 19

diclofenac is contraindicaed with any form of

Answer 19

cardiovascular disease
increase the risk of cardiovascular events

Question 20

on sodium valporate what abx should you avoid and why

Answer 20

Whilst many antibiotics can lower the seizure threshold, this effect is seen particularly with quinolones.
ciprofloxacin

Question 21

Patients with MI secondary to cocaine use should be given

Answer 21

IV benzo

Question 22

serotonin antagonist - drug for chemo induced nausea

Answer 22

Anti-emetics (e.g. ondansetron)

Question 23

ix in carbon monoxide poisoning

Answer 23

pulse oximetry may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin
therefore a venous or arterial blood gas should be taken

Question 24

ototoxic meds

Answer 24

aminoglycosides, high dose salicylates, bumetanide, furosemide, vancomycin

Question 25

87yr female - anuria, confusion over 24hrs , worsening right knee pain, PMH of OA and HTN, previous right hip fracutre on rmapipirl 1.25 NKDA , which of newly preseficbed meds liekly to caused acute presentation - Top ibruprofen, oral ibrprofen, pred 5mg , paracetamol, deep heat gell apply when required -

Answer 25

oral ibuprofen 600mg QDS ( massive dose so think of AKI with anuria and confusion)
Nephotocix meds - ACEi , NSAIDs, aminoglycosides, diuretics, IV contrast, metformin

Question 26

inhibitors of p450 mean

Answer 26

drug is around for longer so increased anticoagulatn effect on warfarin