Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Pharmacology P3 > Flashcards

Pharmacology P3 Flashcards

1
Q

Complications of opioid misuse:

A
  • viral infection due to sharing needles: HIV, hep B and C
  • bacterial - infective endocarditis, septic arthritis, septicaemia, necrotising fasciitis
  • VTE
  • respiratory depression and death
  • psychological
  • social
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Emergency management of opioid overdose:

A

IV or IM naloxone - rapid onset and short duration of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management of opioid dependence:

A

methadone or buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Effect of organophosphate poisoning on receptors:

A
  • inhibition acetylcholinesterase
  • upregulation of nicotinic and muscarinic cholinergic neurotransmission
  • sarin gas similar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Features of organophosphate poisoning:

A

(SLUD)

  • Salivation
  • Lacrimation
  • Urination
  • Defecation
  • Cardiovascular - hypotension, bradycardia
  • small pupils, muscle fasciculation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of organophosphate poisoning:

A

atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of paracetamol poisoning basic:

A
  • activated charcoal if <1 hour ago
  • NAC
  • liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of salicylate poisoning basic:

A
  • urinary alkalisation with IV bicarbonate

- haemodialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of benzodiazepine overdose basic:

A

flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of TCA overdose basic:

A

IV bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of lithium overdose basic:

A
  • volume resuscitation
  • haemodialysis
  • sodium bicarbonate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of methanol poisoning basic:

A
  • fomepizole or ethanol

- haemodialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of iron overdose basic:

A
  • desferrioxamine

- chelating agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of lead poisoning basic:

A
  • dimercaprol

- calcium edetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of cyanide overdose basic:

A
  • hydroxycobalamin

- combination of amyl nitrite, sodium nitrite and sodium thiosulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inducers of P450 system:

A
  • phenytoin, carbamazepine
  • barbiturate: phenobarbitone
  • rifampicin
  • St John’s wort
  • chronic alcohol intake
  • griseofulvin
  • smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Inhibitors of P450 system:

A
  • ciprofloxacin, erythromycin
  • isoniazid
  • cimetidine, omeprazole
  • amiodarone
  • allopurinol
  • ketoconazole, fluconazole
  • SSRI: fluoxetine, sertraline
  • ritonavir
  • sodium valproate
  • acute alcohol intake
  • quinupristin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should acetylcysteine be given in paracetamol overdose?

A
  • if staggered overdose or doubt over time of ingestion regardless of plasma conc
  • plasma conc is on or above treatment line regardless of risk factors of hepatotoxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is NAC given and what is a possible reaction?

A
  • infused over 1 hour to reduce ADR
  • causes anaphylactoid reaction - non-IgE mediated mast cell release
  • stop transfusion and restart at slower rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Criteria for liver transplantation in paracetamol liver failure:

A
  • arterial pH <7.3 24 hours after ingestion

- OR PT >100sec + creatinine >300micromol/L + grade III or IV encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Who is at increased risk of developing hepatotoxicity following paracetamol overdose:

A
  • taking liver enzyme inducing drugs
  • malnourished patients
  • acute alcohol intake is protective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is first pass metabolism and what drugs does this apply to?

A
  • concentration of drug is greatly reduced before it reaches systemic circulation due to hepatic metabolism
  • larger oral dose needed
  • aspirin, isosorbide dinitrate, GTN, lignocaine, propranolol, verapamil, isoprenaline, testosterone, hydrocortisone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is zero-order kinetics and what drugs exhibit this?

A
  • metabolism is independent of concentration of reactant
  • metabolic pathway becomes saturated
  • phenytoin, salicylates (e.g. high dose aspirin), heparin, ethanol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are examples of phosphodiesterase type V inhibitors and how do they work?

A
  • vasodilation through increase in cGMP leading to smooth muscle relaxation in blood vessels supplying corpus cavernosum
  • sildenafil (viagra) - short acting (1 hour before)
  • tadalafil - longer acting, take on regular
  • vardenafil
  • also used to manage pulmonary hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Contraindications to PDE5 inhibitors:

A
  • taking nitrates and related drugs e.g. nicorandil
  • hypotension
  • recent stroke or MI (wait 6 months)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Side effects of PDE5 inhibitors:

A
  • visual disturbance: blue discolouration, non-arteritic anterior ischaemic neuropathy
  • nasal congestion
  • flushing
  • GI side effects
  • headache
  • priapism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the potassium sparing diuretics:

A
  • epithelial sodium channel blockers: amiloride and triamterene
  • aldosterone antagonists: spironolactone and eplerenone
  • caution if taking ACEi as they precipitate hyperkalaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does amiloride work?

A
  • blocks epithelial sodium channels in distal convoluted tubule
  • weak diuretic, given with thiazides or loop diuretics as alternative to potassium supplementation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do aldosterone antagonists like spironolactone work?

A
  • act in cortical collecting duct

- used for ascites, heart failure, nephrotic syndrome and Conn’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Drugs to avoid in renal failure:

A
  • antibiotics: tetracycline, nitrofurantoin
  • NSAIDs
  • lithium
  • metformin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Drugs likely to accumulate in CKD so need dose adjustment:

A
  • most antibiotics
  • digoxin, atenolol
  • methotrexate
  • sulphonylureas
  • furosemide
  • opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Drugs harmful in pregnancy:

A
  • tetracyclines
  • aminoglycosides
  • sulphonamides and trimethoprim
  • quinolones
  • ACEi and ARBs
  • statins
  • warfarin
  • sulfonylureas
  • retinoids
  • cytotoxics
  • antiepileptics
33
Q

What are quinolone and how do they work?

A
  • inhibit DNA synthesis and are bactericidal
  • e.g. ciprofloxacin and levofloxacin
  • inhibit topoisomerase II and topoisomerase IV
34
Q

ADR of quinolones and CONTRA:

A
  • lower seizure threshold
  • tendon damage
  • cartilage damage
  • lengthens QT interval
  • avoid in pregnancy and breastfeeding and G6PD
35
Q

What is the acid base balance like in salicylate overdose:

A
  • early stimulation of respiratory centre leads to respiratory alkalosis
  • later on, the acid effects of salicylates lead to metabolic acidosis
36
Q

Features of salicylate overdose:

A
  • hyperventilation
  • tinnitus
  • lethargy
  • sweating, pyrexia
  • nausea and vomiting
  • hyperglycaemia and hypoglycaemia
  • seizures
  • coma
37
Q

Indications for haemodialysis in salicylate overdose:

A
  • serum conc >700mg/L
  • metabolic acidosis resistant to treatment
  • acute renal failure
  • pulmonary oedema
  • seizures
  • coma
38
Q

Causes of serotonin syndrome:

A
  • MAOI
  • SSRI - St John’s wort can interact
  • ecstacy
  • amphetamines
39
Q

Features of serotonin syndrome:

A
  • neuromuscular excitation: hyperreflexia, myoclonus, rigidity
  • ANS excitation: hyperthermia, sweating
  • altered mental state: confusion
40
Q

Management of serotonin syndrome:

A
  • IV fluids
  • benzodiazepines
  • serotonin antagonists e.g. cyprohepatidine or chlorpromazine
41
Q

Side effects ACEi:

A
  • cough

- hyperkalaemia

42
Q

Side effects bendroflumethiazide:

A
  • gout
  • hypokalaemia
  • hyponatraemia
  • impaired glucose tolerance
43
Q

Side effects calcium channel blockers:

A
  • headache
  • flushing
  • anke oedema
44
Q

Side effects beta blockers:

A
  • bronchospasm
  • fatigue
  • cold peripheries
45
Q

Side effects doxazosin:

A

postural hypotension

46
Q

Side effects amoxicillin:

A

rash with infectious mononucleosis

47
Q

Side effects co-amoxiclav:

A

cholestasis

48
Q

Side effects flucloxacillin:

A

cholestasis after a few weeks

49
Q

Side effects erythromycin:

A
  • GI upset

- prolonged QT

50
Q

Side effects ciprofloxacin:

A
  • lowers seizure threshold

- tendonitis

51
Q

Side effects metronidazole:

A

reaction with alcohol

52
Q

Side effects doxycycline:

A

photosensitivity

53
Q

Side effects trimethoprim:

A
  • rashes
  • photosensitivity
  • pruritus
  • suppression of haematopoiesis
54
Q

Side effects sulfonylureas:

A
  • hypoglycaemia
  • increased appetite and weight gain
  • SIADH
  • liver dysfunction
55
Q

Side effects glitazones:

A
  • weight gain
  • fluid retention
  • liver dysfunction
  • fractures
56
Q

Side effect gliptins:

A

pancreatitis

57
Q

What is St John’s wort:

A
  • as effective as TCA in mild-moderate depression

- similar MOA to SSRI

58
Q

ADR St John’s wort:

A
  • serotonin syndrome
  • inducer of P450 system
  • effectiveness of COCP reduced
59
Q

What is tamoxifen and how is it used?

A

-SERM
-oestrogen receptor antagonist and partial agonist
-oestrogen receptor positive breast cancer
-used for 5 years following tumour removal
(raloxifene is pure antagonist and carries lower endometrial cancer risk)

60
Q

ADR tamoxifen:

A
  • menstrual disturbance: bleeding, amenorrhoea
  • hot flushes
  • VTE
  • endometrial cancer
61
Q

What teratogenic effect do ACEi have:

A
  • renal dysgenesis

- craniofacial abnormalities

62
Q

What teratogenic effect does alcohol have?

A

craniofacial abnormalities

63
Q

What teratogenic effect do aminoglycosides have?

A

ototoxicity

64
Q

What teratogenic effect does carbamazepine have?

A
  • NTD

- craniofacial

65
Q

What teratogenic effect does chloramphenicol have?

A

grey baby syndrome

66
Q

What teratogenic effect does cocaine have?

A
  • IUGR

- preterm labour

67
Q

What teratogenic effect does diethylstilbestrol have?

A

vaginal clear cell adenocarcinoma

68
Q

What teratogenic effect does lithium have?

A

Ebstein’s anomaly

69
Q

What teratogenic effect do tetracyclines have?

A

discoloured teeth

70
Q

What teratogenic effect does thalidomide have?

A

limb reduction

71
Q

What teratogenic effect does warfarin have?

A

craniofacial abnormalities

72
Q

How do you treat theophylline toxicity?

A
  • activated charcoal regardless of time
  • haemodialysis
  • IV crystalloid for hypotension
  • diazepam for seizures
  • IV beta blockers for SVTs
  • antiemetics
73
Q

Normal lithium therapeutic range:

A

0.4-1.0mmol/L

74
Q

TCA overdose features:

A
  • anticholinergic: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision
  • severe: arrhythmias, seizures, metabolic acidosis, coma
75
Q

ECG changes with TCA overdose:

A
  • sinus tachy
  • QRS >100ms - seizures
  • QRS >160ms - ventricular arrhythmias
76
Q

MOA and ADR of rifampicin:

A
  • inhibits bacterial DNA dependent RNA polymerase and prevents DNA to mRNA transcription
  • potent liver enzyme inducer, hepatitis, orange secretions, flue like symptoms
77
Q

MOA and ADR of isoniazid:

A
  • inhibits mycolic acid synthesis
  • peripheral neuropathy: prevent with pyridoxine
  • hepatitis, agranulocytosis
  • liver enzyme inhibitor
78
Q

MOA and ADR of pyrizinamide:

A
  • converts pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase
  • hyperuricaemia causing gout
  • arthralgia, myalgia
  • hepatitis
79
Q

MOA and ADR of ethambutol:

A
  • inhibits enzyme arabinosyl transferase which polymerises arabinose into arabinan
  • optic neuritis: check visual acuity before and during

Pharmacology (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions