Pharmacology P2 Flashcards
1
Q
Features of ecstasy poisoning:
A
- neurological: agitation, anxiety, confusion, ataxia
- cardiovascular: tachycardia, hypertension
- HYPONATRAEMIA
- hyperthermia
- rhabdomyolysis
2
Q
Management of ecstasy poisoning:
A
- supportive
- dantrolene for hyperthermia
3
Q
Features of ethylene glycol toxicity (stages):
A
- stage 1: like alcohol - confusion, slurred speech, dizziness
- stage 2: metabolic acidosis with high anion gap and high osmolar gap, tachycardia, HTN
- stage 3: AKI
4
Q
Management of ethylene glycol toxicity:
A
- fomepizole - alcohol dehydrogenase inhibitor
- haemodialysis
5
Q
What is finasteride and what is it used for?
A
- 5-alpha reductase inhibitor
- metabolises testosterone to dihydrotestosterone
- used for BPH and male pattern baldness
6
Q
ADR of finasteride:
A
- impotence
- reduced libido
- ejaculation disorders
- gynaecomastia and breast tenderness
- (reduced serum PSA)
7
Q
What is flecainide and what is it used for?
A
- class 1c antiarrhythmic
- slows conduction of AP by acting as sodium channel blocker
- used in AF and SVT associated with accessory pathway (WPW)
8
Q
Contraindications of flecainide:
A
- post MI
- structural heart disease e.g. HF
- sinus node dysfunction, second or third degree AV block
- atrial flutter
9
Q
ADR flecainide:
A
- negatively inotropic
- bradycardic
- proarrhythmic
- oral paraesthesia
- visual disturbance
10
Q
What kind of antibiotic is gentamicin and what is it used for?
A
- aminoglycoside
- poorly lipid double so given parentally (infective endocarditis) or topically (otitis externa)
11
Q
ADR of gentamicin and contraindication:
A
- ototoxicity: auditory or vestibular nerve damage, irreversible
- nephrotoxicity: accumulates in renal failure, acute tubular necrosis, concomitant use of furosemide increases risk
- CONTRA: myasthenia gravis
12
Q
How do different heparins work:
A
- activate antithrombin III
- unfractionated: complex which inhibits thrombin, Xa, IXa, XIa and XIIa
- LMWH: increases action antithrombin III on factor Xa
13
Q
ADR heparin:
A
- bleeding
- thrombocytopaenia
- osteoporosis
- hyperkalaemia (inhibits aldosterone secretion)
14
Q
How can you monitor standard heparin and when is it typically used?
A
- APTT
- used if high risk of bleeding as anticoagulation can be terminated rapidly
- also in renal failure
15
Q
How can you monitor LMWH and when is it used?
A
- anti-factor Xa
- management VTE and prophylaxis
- also ACS
16
Q
How does heparin-induced thrombocytopenia come about?
A
- immune mediated antibodies formed against complexes of platelet factor 4 and heparin
- induce platelet activation
- usually after 5-10 days of treatment
- low platelets but prothrombotic condition
- may need direct thrombin inhibitor e.g. argotroban or danaparoid
17
Q
How is heparin overdose reversed?
A
protamine sulphate
18
Q
Indications of HRT:
A
- vasomotor symptoms e.g. flushing, insomnia and headaches
- premature menopause: continue until 50yo
- also reduces incidence of CRC
19
Q
Types of HRT:
A
- oestrogens
- progestogens
- tibolone: synthetic oestrogen + progesterone + androgenic activity
20
Q
What route of HRT is preferred if at risk of VTE?
A
transdermal
21
Q
Causes of low magnesium:
A
- drugs: diuretics, PPI
- total parenteral nutrition
- diarrhoea
- alcohol
- hypokalaemia
- hypercalcaemia e.g. secondary hyperparathyroidism
- metabolic disorder e.g. Gitleman’s or Bartter’s
22
Q
Features of hypomagnesaemia:
A
- similar to hypocalcaemia
- paraesthesia
- tetany
- seizures
- arrhythmias
- reduced PTH secretion - hypocalcaemia
- ECG similar to hypokalaemia
- exacerbates digoxin toxicity
23
Q
Treatment of hypomagnesaemia:
A
<0.4mmol/L or tetany, arrhythmias or seizures:
- IV magnesium replacement
- e.g. 40mmol magnesium sulphate over 24 hours
> 0.4mmol/L
- oral magnesium salts
- diarrhoea may occur
24
Q
What can lithium toxicity be precipitated by:
A
- dehydration
- renal failure
- drugs: diuretics, ACEi and ARBs, NSAIDs and metronidazole
25
Features lithium toxicity:
- coarse tremor
- hyperreflexia
- acute confusion
- polyuria
- seizure
- coma
26
Management of lithium toxicity:
- volume resuscitation with normal saline if mild
| - haemodialysis
27
Symptoms of LSD intoxication:
- psychoactive: impaired judgement, euphoria or dysphoria, agitation, psychosis
- somatic: nausea, headache, palpitations, dry mouth, drowsiness, tremor
- signs: tachycardia, HTN, mydriasis, paraesthesia, hyperreflexia, pyrexia
28
Massive overdose of LSD complications:
- respiratory arrest
- coma
- hyperthermia
- autonomic dysfunction
- bleeding disorders
29
How do macrolides work?
- inhibit bacterial protein synthesis by blocking translocation
- post transcriptional methylation of 23S bacterial ribosomal RNA
30
ADR of macrolides and interaction:
- prolongation QT interval
- GI side effects
- cholestatic jaundice
- P450 inhibitor
- azithromycin - hearing loss and tinnitus
- stop taking statins - increased risk of myopathy and rhabdomyolysis
31
What type of drug is metformin and MOA:
- bigaunide
- activation of AMPK
- increases insulin sensitivity
- decreases hepatic gluconeogenesis
- reduces GI absorption of carbohydrates
32
ADR metformin:
- GI upsets common
- reduced vitamin B12 absorption
- lactic acidosis with severe liver disease or renal failure
33
Contraindications of metformin:
- CKD
- recent MI, sepsis, AKI, severe dehydration
- iodine containing x-ray contrast media
- alcohol abuse relative contraindications
34
How should metformin be started:
- titrated up slowly to reduce GI side effects
| - modified release metformin should be considered
35
Effects of methanol poisoning:
- blindness
| - form of optic neuropathy due to accumulation of formic acid
36
Management of methanol poisoning:
- fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
- haemodialysis
- cofactor therapy with colonic acid to reduce ophthalmological complications
37
Motion sickness management:
- hyoscine (transdermal patch)
| - non-sedating antihistamines e.g. cyclizine or cinnarizine
38
What is octreotide and what is it used for?
- long-acting analogue of somatostatin
- released form D cells of pancreas and inhibits release of GH, glucagon and insulin
- acute treatment variceal haemorrhage, acromegaly, carcinoid syndrome, prevent complications following pancreatic surgery, VIPomas, refractory dirrhoea
39
Adverse effect of octreotide:
gallstones (secondary to biliary stasis)
40
What is an oculogyric crisis:
- dystonic reaction to certain drugs or conditions
- restlessness and agitation
- involuntary upward deviation of the eyes
41
Causes of oculogyric crisis and management:
- antipsychotics
- metoclopramide
- postencephalitic Parkinson's
- manage with IV antimuscarinic: benztropine or procyclidine
