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Pharmacology > Pharmacology P2 > Flashcards

Pharmacology P2 Flashcards

1
Q

Features of ecstasy poisoning:

A
  • neurological: agitation, anxiety, confusion, ataxia
  • cardiovascular: tachycardia, hypertension
  • HYPONATRAEMIA
  • hyperthermia
  • rhabdomyolysis
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2
Q

Management of ecstasy poisoning:

A
  • supportive

- dantrolene for hyperthermia

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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
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4
Q

Management of ethylene glycol toxicity:

A
  • fomepizole - alcohol dehydrogenase inhibitor

- haemodialysis

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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
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6
Q

ADR of finasteride:

A
  • impotence
  • reduced libido
  • ejaculation disorders
  • gynaecomastia and breast tenderness
  • (reduced serum PSA)
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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)
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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
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9
Q

ADR flecainide:

A
  • negatively inotropic
  • bradycardic
  • proarrhythmic
  • oral paraesthesia
  • visual disturbance
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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)

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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
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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
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13
Q

ADR heparin:

A
  • bleeding
  • thrombocytopaenia
  • osteoporosis
  • hyperkalaemia (inhibits aldosterone secretion)
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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
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15
Q

How can you monitor LMWH and when is it used?

A
  • anti-factor Xa
  • management VTE and prophylaxis
  • also ACS
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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
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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
Q

Features lithium toxicity:

A
  • coarse tremor
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
26
Q

Management of lithium toxicity:

A
  • volume resuscitation with normal saline if mild

- haemodialysis

27
Q

Symptoms of LSD intoxication:

A
  • psychoactive: impaired judgement, euphoria or dysphoria, agitation, psychosis
  • somatic: nausea, headache, palpitations, dry mouth, drowsiness, tremor
  • signs: tachycardia, HTN, mydriasis, paraesthesia, hyperreflexia, pyrexia
28
Q

Massive overdose of LSD complications:

A
  • respiratory arrest
  • coma
  • hyperthermia
  • autonomic dysfunction
  • bleeding disorders
29
Q

How do macrolides work?

A
  • inhibit bacterial protein synthesis by blocking translocation
  • post transcriptional methylation of 23S bacterial ribosomal RNA
30
Q

ADR of macrolides and interaction:

A
  • 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
Q

What type of drug is metformin and MOA:

A
  • bigaunide
  • activation of AMPK
  • increases insulin sensitivity
  • decreases hepatic gluconeogenesis
  • reduces GI absorption of carbohydrates
32
Q

ADR metformin:

A
  • GI upsets common
  • reduced vitamin B12 absorption
  • lactic acidosis with severe liver disease or renal failure
33
Q

Contraindications of metformin:

A
  • CKD
  • recent MI, sepsis, AKI, severe dehydration
  • iodine containing x-ray contrast media
  • alcohol abuse relative contraindications
34
Q

How should metformin be started:

A
  • titrated up slowly to reduce GI side effects

- modified release metformin should be considered

35
Q

Effects of methanol poisoning:

A
  • blindness

- form of optic neuropathy due to accumulation of formic acid

36
Q

Management of methanol poisoning:

A
  • fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
  • haemodialysis
  • cofactor therapy with colonic acid to reduce ophthalmological complications
37
Q

Motion sickness management:

A
  • hyoscine (transdermal patch)

- non-sedating antihistamines e.g. cyclizine or cinnarizine

38
Q

What is octreotide and what is it used for?

A
  • 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
Q

Adverse effect of octreotide:

A

gallstones (secondary to biliary stasis)

40
Q

What is an oculogyric crisis:

A
  • dystonic reaction to certain drugs or conditions
  • restlessness and agitation
  • involuntary upward deviation of the eyes
41
Q

Causes of oculogyric crisis and management:

A
  • antipsychotics
  • metoclopramide
  • postencephalitic Parkinson’s
  • manage with IV antimuscarinic: benztropine or procyclidine

Pharmacology (4 decks)

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