Pharmacology (PSA) Flashcards
What are the drugs associated with pancreatitis?
FATSHEEP
Furosemide
Azathioprine/Asparaginase
Thiazides/Tetracyclines
Statins/Sulfonamides/Sodium Valproate
Hydrochlorothiazide
Estrogens
Ethanol
Protease Inhibitors
What diabetic medications can increase risk of gangrene?
SGLT-2 Inhibitors
What electrolyte imbalance can omeprazole cause?
Hypomagnesaemia
What is an appropriate set of blood tests to monitor for adverse effects of Methotrexate?
FBC, U&E and LFTs
What should be checked when taking amiodarone?
TFTs every six months
What drugs should be stopped before surgery?
Insulin
Lithium
Anticoagulants/antiplatelets
COCP/HRT
K-Sparing diuretics
Oral Hypoglycaemics
Perindoprin and other ACE inhibitors
Which patients should you avoid Metoclopramide prescription in?
Patients with Parkinson’s disease, due to the risk of exacerbating symptoms
Young women, due to the risk of dyskinesia, i.e. unwanted movements especially acute dystonia
What drug class are contraindicated in ishcaemic leg ulcers?
Beta blockers
Beta-blockers can cause peripheral vasoconstriction and so worsen ischaemia in peripheral vascular disease (PVD), as such this patient’s atenolol is now contraindicated.
What drugs may be harmful in heart failure?
Calcium channel blockers (e.g. verapamil, diltiazem)
Tricyclic antidepressants
Lithium
NSAIDs and COX-2 inhibitors
Corticosteroids
QT-prolonging medications
What can metformin cause?
Lactic Acidosis
What are the most nephrotoxic antibiotics?
Gentamicin, Vancomycin and Tetracyclines
First line for paediatric status epilepticus in the community?
Diazepam PR
Midazolam Buccal
First line drug for Urge incontinence
Oxybutynin Hydrochloride
2.5mg-3mg
PO
BD
When should you give prednisolone
AM
What drugs increase fracture risk?
Steroids (e.g. Prednisolone)
PPIs
GnRH agonists (Buserelin, Goserelin)
Which drugs increase the risk of falls?
Benzodiazepines
Antidepressants (particularly TCAs and SNRIs)
Monoamine oxidase inhibitors
Most antipsychotics
Opiates
Most antihypertensives (particularly diuretics and alpha-blockers)
Which antidiabetic drugs can cause weight gain?
Thiazolidinediones (e.g. Pioglitazone)
Sulfonylurea (e.g. Gliclazide)
What drugs increase risk of pancreatitis?
Ethanol
DDP4 Inhibitors
GLP-1 analogues
Mesalazine>Sulphasalazine
What drugs should you stop in AKI?
Diuretics
ACEi/ARBs
Metformin
NSAIDs
Who should low oxygen therapy be reserved for?
COPD
Advanced CF
Severe non-cystic fibrosis bronchiectasis
Severe Kyphoscoliosis or Ankylosing spondylitis
Lung scarring in TB
MSK disorders with respiratory weakness
An overdose of opioids, benzos or other drugs causing respiratory depression.
ECG in hyperkalaemia
Absent P waves, Prolonged QRS, Peaked or ‘tall tented’ T waves, Sine wave pattern
What is the preferred route of administration for Vancomycin in C. diff
Orally
IV vancomycin is not as effective as it cannot reach the bowel
What is the King’s College Hospital criteria used to determine and what are they?
Used to determine whether Liver Transplant is needed post paracetamol ingestion
Arterial pH >7.3 after 24 hours of treatment
Or ALL of - INR >6.5 creatinine AND grade 3/4 encephalopathy
What is the treatment for tricyclic antidepressant overdose and why?
Sodium Bicarbonate.
TCA overdoses cause sodium channel blocking in the myocardium which can result in arrythmias.
The first sign in QRS prolongation.
Sodium bicarbonate increases TCA protein binding, dislodging the TCAs from the sodium channel and increasing TCA elimination
What tests should be carried out before starting lithium therapy?
FBC, U&E, TFT, BMI +/- ECG before and every 6 months
What are symptoms of lithium toxicity?
Muscle weakness –> Dizziness –> Ataxia –> Coarse tremor –> Seizures –> Disorientation –> Coma –> Death
Which drugs cause hypoglycaemia?
Insulin, Sulphonylureas
What drugs cause hyperglycaemia?
Steroids, antipsychotics, thiazides, beta blockers, tacrolimus
What drugs can cause constipation?
Opioids
Iron
CCBs (Verapamil, amlodipine)
Ondansetron and Metoclopramide
Anticholinergics
What drugs can cause diarrhoea?
Antibiotics (C.Diff), Colchicine, Metformin, PPIs, Antacids contains magnesium and Laxatives
What drugs can cause urinary retention?
Opioids, Anticholinergics
NSAIDs, Disopyramide
Tricyclic antidepressants
What drugs can cause urinary incontinence?
Alpha-blockers, diuretics, ACTH inhibitors, Clozapine
What drugs are cytochrome P450 INDUCERS
Carbamazepine
Barbiturates
Phenytoin
Rifampin
Griseofluvin
St John’s Wart
Modafinil
Cyclophosphamide
What drugs are Cytochrome P450 INHIBITORS
Amiodarone
Cimetidine
Fluoroquinolones
Clarithromycin
Azole Antifungals
Grapefruit juice
Isoniazid
Ritonavir
What dose of Adrenaline is give to an adult in anaphylaxis?
500micrograms of 1 in 1,000 IM
What dose of Adrenaline is given to an adult in cardiac arrest and has a non-shockable rhythm?
Adrenaline 1mg as 1 in 10,000 IV
What drug is used to treat bradycardia when there are signs of shock?
Atropine 500micrograms IV
What drugs should be avoided in Pregnant patients?
ACEi
ARBs
Statins
Warfarin
Sulfonylureas
Retinoids (including topical)
Cytotoxic agents
Majority of antiepileptics
Certain antibiotics
Exacerbating factors for Psoriasis?
Trauma Alcohol
Beta blockers
Lithium
Antimalarials (Chloroquine and hydroxychloroquine)
NSAIDS
ACEi
Infliximab
Withdrawal of systemic steroids
What drugs may worsen seizure control?
- Alcohol Cocaine and Amphetamines
- Ciprofloxacin, levofloxacin
- Aminophylline, Theophylline
- Bupropion
- Methylphenidate
- Mefenamic Acid
When is ACEi first line?
Under 55
T2DM
Methotrexate monitoring?
Patients should have full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.
What is the treatment for aspirin poisoning?
- Activated Charcoal if given within 1 hour of ingesting more than 125mg/kg of aspirin.
- IV sodium bicarbonate may be given to enhance urinary salicylate excretion
- Haemodialysis is the treatment of choice in severe poisoning and should be considered when the plasma-salicylate concentration exceeds 700mg/litre or in the presence of severe metabolic acidosis.
What is the treatment for tricyclic antidepressant poisoning?
- Supportive measures
- IV Lorazepam or IV Diazepam may be required to treat convulsions
- IV infusion of Sodium Bicarbonate can arrest arrhythmias or prevent them in those with an extended QRS duration.
What is the treatment for Benzodiazepine poisoning?
- Activated Charcoal can be given within 1 hour of ingesting a significant quantity of benzodiazepine.
- Flumazenil use can be hazardous but may prevent the need for ventilation.
What is the first line treatment for Whooping cough?
Clarithromycin
What drugs impair glucose tolerance?
- Thiazides
- Steroids
- Tacrolimus, ciclosporin
- Interferon-alpha
- Nicotinic acid
- Antipsychotics
Beta blockers cause a slight impairment of glucose tolerance. They should also be used with caution in diabetics as they interfere with the metabolic and autonomic responses to hypoglycaemia.
What drugs can cause lung fibrosis?
- Amiodarone
- Cytotoxic agents: Busulphan, Bleomycin
- Anti-rheumatoid drugs: Methotrexate, Sulfasalazine
- Nitrofuratoin
- Bromocriptine, cabergoline, pergolide
What is the Lithium range and when should the test be taken?
Range= 0.4-1.0mmol/L
Take it 12 hours post-dose
When should you take ciclosporin trough levels?
Immediately before dose
When should you take Digoxin levels?
At least 6 hours post-dose
First line treatment options for Acne?
Mild- Moderate: Benzoyl peroxide with clindamycin
Moderate-Severe: Adapalene with benzoyl peroxide + Lymecycline or doxycycline
Initial drug treatment of STEMI?
DAPT. Choice of second antiplatelet depends on the planned intervention.
What is the second antiplatelet preferred for patients undergoing primary PCI?
Prasugrel
What medications should people take for secondary prevention of cardiovascular events?
ACEi + B-Blocker + DAPT + Statin
What is used for the prevention of Rheumatic fever?
Phenoxymethylpenicillin
What antibiotics should be used in PPROM to prevent intra-uterine infection?
Erythromycin
How long should antidepressants be continued before considering swapping due to lack of efficacy?
4 weeks (6weeks in the elderly)
First line drug used in assisted alcohol withdrawal?
Long acting benzodiazepine such as Chlordiazepoxide
What is the most effective form of emergency contraception?
Copper intra-uterine device
Can be inserted up to five days after the first UPSI in a natural menstrual cycle.
First line for BV?
Oral metronidazole - Suggested duration of treatment 5-7 days (or high-dose metronidazole as a single dose)
First line for uncomplicated chlamydia?
Doxycycline
First line for uncomplicated gonorrhoea?
If antimicrobial susceptibility unknown –> Ceftriaxone
First line for Pelvic inflammatory disease?
Doxycycline + Metronidazole + Single dose of I/M Ceftriaxone or ofloxacin
First line for early syphilis?
Benzathine Benzylpenicillin
What do you give for suspected Meningitis in primary care?
Benzylpenicillin Sodium injection (600mg, 1.2g)
NEONATE 300 mg
CHILD 1 MONTH–11 MONTHS 300 mg
CHILD 1–9 YEARS 600 mg
CHILD 10–17 YEARS 1.2 g
ADULT 1.2 g
or if history of allergy to penicillin
Cefotaxime injection (500 mg, 1 g, 2 g)
By intravenous injection (or by intramuscular injection if venous access not available)
NEONATE 50 mg/kg
CHILD 1 MONTH–15 YEARS 50 mg/kg (max. 2 g)
CHILD 16–17 YEARS 2 g
ADULT 2 g
Note A single dose
What does HRT increase the risk of?
VTE, Stroke, Endometrial cancer, breast cancer, and ovarian cancer
What should be monitored to assess adverse effects of HRT?
BP
What are some examples of preemptives and what are they used for?
- Morphine for pain and breathlessness
- Midazolam for agitation
- Levomepromazine or Haloperidol for nausea and vomiting and delirium
- Hyoscine Butylbromide for respiratory secretions
What is Baclofen used for?
First line for muscle spasm, spasticity and cramp in palliative care.
What are some contraindications for Beta-blockers?
Asthma, cardiogenic shock, hypotension, marked bradycardia, metabolic acidosis, phaechromocytoma (apart from specific use with alpha blockers), second degree AV block, severe peripheral arterial disease, sick sinus syndrome, third degree AV block, uncontrolled heart failure
What are some contraindications for ACEi?
Hereditary or idiopathic angioedema; history of angioedema associated with prior ACE inhibitor therapy; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m2; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
What electrolyte imbalance can unfractionated heparin cause?
Hyperkalaemia
