Pharmacology on passmed yr 5 Flashcards
what is the difference between a fine tremour and a coarse tremor and when is it seen with lithium use
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
what is a coarse intention tremor
coarse intention tremor (worse with goal-directed movements) of a slow frequency.
seen in cerebellar stroke
what things might precipitate lithium toxicity
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
some other features of lithium toxicity
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
monitoring repsonse to dalteparin what factor do you measure
10a
in renal failure what heparin in better
unfractionated - so would need to monitor APTT
adrenaline doses in anaphylaxis and cardiac arrest
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
gingerval hyperplasia - overgrowth of gums caused by what 3 medications
phenytoin, cyclosporine, or calcium channel blockers.
drug or medical causes of low magnesium
diuretics
proton pump inhibitors
total parenteral nutrition
tx of low magnesium depending on value
<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
statins need to monitor
LFT
Creatine kinase levels do not need to be routinely monitored unless there is a suspicion of myopathy
Azathioprine monitoring
FBC lFT
amiodarone drug monitoring
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
warfarin stopped how long before surgery
Warfarin is usually stopped 5 days pre-operatively
in renal failure or disease for treating VTW why is using unfractionated heparin better than LMWH
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:
drugs used for motion sickness
Motion sickness - hyoscine(patch) > cyclizine > promethazine
corneal opacities side effect of what drug
amiodarone
indomethacin
what drug can cause optic neuritis
ethambutol
amiodarone
metronidazole
diclofenac is contraindicaed with any form of
cardiovascular disease
increase the risk of cardiovascular events
on sodium valporate what abx should you avoid and why
Whilst many antibiotics can lower the seizure threshold, this effect is seen particularly with quinolones.
ciprofloxacin
Patients with MI secondary to cocaine use should be given
IV benzo
serotonin antagonist - drug for chemo induced nausea
Anti-emetics (e.g. ondansetron)
ix in carbon monoxide poisoning
pulse oximetry may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin
therefore a venous or arterial blood gas should be taken
ototoxic meds
aminoglycosides, high dose salicylates, bumetanide, furosemide, vancomycin
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 -
oral ibuprofen 600mg QDS ( massive dose so think of AKI with anuria and confusion)
Nephotocix meds - ACEi , NSAIDs, aminoglycosides, diuretics, IV contrast, metformin
inhibitors of p450 mean
drug is around for longer so increased anticoagulatn effect on warfarin
ventolin also known as
salbutamol
what adjunct can you use to kepra
Lacosamide
POP names of progesterone brand hormones (3)
levongestrel, norethistone, desogestrel
