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Maud- Phase 3b > Pharmacology/PSA > Flashcards

Pharmacology/PSA Flashcards

1
Q

What type of drug is amiloride and what does it do?

A

Potassium-sparing diuretic used to reduce K+ losses

e.g in patients taking other diuretics

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2
Q

What type of drug is Digoxin and when might it be given

A

Cardiac glycoside

Rate control drug given in AF (particularly ptx with HF)

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3
Q

What is Bumetanide an example of? Give another?

A

Loop diuretic

Other- furosemide

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4
Q

What in Indapamide an example of? Give another?

A

Thiazide-like diuretic

Other= bendroflumethiazide

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5
Q

What is Diltiazem an example of? Give another?

A

Non-dihydropyridine
Other= verapamil

These are CCBs selective for the heart for rate control

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6
Q

Give an indication for amiodarone?

A

Rate + Rhythm control in AF

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7
Q

Class and indication for Doxazosin?

A

Alpha blocker

HTN and BPH

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8
Q

What is the MOA for statins?

A

Inhibit MHC Co A reductase therefore preventing synthesis of chloesterol

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9
Q

Class, MOA and indication for metoprolol?

A

Beta blocker (B1 selective)
Reduces force of contraction and speed of electrical conduction
Supraventricular tachycardias, AF (rate control)

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10
Q

Where would you find B1, B2, B3 adrenoceptors?

A 
B1= heart 
B2= smooth muscle e.g in bronchioles
B3= adipose tissue
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11
Q

What are the SEs of statins?

How can we monitor their effect?

A

Elevated liver enzymes and muscle SEs (myopathy/rhabdomyolysis)
Liver profile measured before statin and after 3 months
If liver transaminase levels >3 times normal limit then stop drugs

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12
Q

Before prescribing statins, which 2 investigations should you consider?

A

Liver profile- to monitor potential SEs of statins

TFTs- to detect hypothyroidism- a reversible cause of hyperlipidaemia

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13
Q

What is contained within an Epipen? When and how should you administer it?

A

300mg adrenaline
IM anterolateral thigh, held for 10 seconds

Note cartridge contains 2mg adrenaline in 1mg/1ml solution so only 0.3ml actually injected

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14
Q

Fluticasone is an example of what drug?

A

Inhaled corticosteroid

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15
Q

Hycosine butylbromide is an example of what? When is it indicated?

A

Antimuscarinic
1st line pharmacological tx of IBS (anti-motility)
palliative drug to reduce copious resp secretions

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16
Q

Which class of drug should non-dihydropyridines e.g verapamil NOT be prescribed with? What happens if they are?

A

Beta-blockers

Cause heart block, cardiogenic shock, asystole

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17
Q

What is meant by third-degree heart block?

A

Transmission between atria and ventricles is completely blocked, they now beat independently

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18
Q

What goes in the medicines reconciliation section on a hospital drugs chart?

A

Drugs that patients were taking prior to admission
Who told you
Any changes made on admission

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19
Q

What is meant by patient-specific direction?

A 
Written instructions,
From independent prescriber (e.g doctor)
For a medicine to be supplied/administered
To a named patient 
Assessed on an individual basis

(hospital prescription must be accompanied by entry in medical records)

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20
Q

How does obtaining consent for prescriptions on a hospital ward work?

A

Assumed consent on hospital wards

Seek consent if high risk of adverse effects or off-license use of drug

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21
Q

What information should be written about a medicine when prescribing it on a hospital chart?

A 
Name of generic medicine 
Route 
Form 
Strength 
Timing / Frequency 
Start and stop date (+/- review date)
Other relevant information
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22
Q

When might you prescribe a branded drug over a generic drug?

A

Generic drug has different available release forms e.g oxycodone (generic): oxynorm= immediate release, oxycontin= modified release
Combination products- brand name contains mix of products, easier than prescribing individual drugs
Drug has narrow therapeutic index

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23
Q

Which abbreviations are acceptable for hospital prescriptions?

A

Kg, g, mg

L, ml

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24
Q

What are the following routes abbreviations:

PO, IV, IM, SC, SL, PR, PV, NG, INH, TOP

A

PO= oral. IV= intravenous. IM= intramuscular. SC= subcutaneous. SL=sublingual. PR= per rectum. NG= nasogastric. INH= inhaled. TOP= topical

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25
Q

What is meant by the following abbreviations relevant to prescribing:
PEG, PEJ, NG, NJ, LE. RE, BE, IA, SC pump

A 
PEG= via PEG (percutaneous endoscopic gastrostomy)
PEJ= via PEJ (percutaneous endoscopic jejunostomy)
NG= nasosgastric. NJ= nasojejunal. 
LE= left eye. RE= right eye. BE= both eyes. 
IA= intraarticular. SC pump= via subcutaneous pump.
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26
Q

The patient is unconscious when they arrive at hospital but their relative informs you they are allergic to penicillin. What 3 things should you do?

A

Document allergy on drugs chart
Record on patient ID bracelet (may be colour-coded)
Alert nurse for nurse-led caring records

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27
Q

VTE assessments are required for all patients admitted to hospital over what age?

A

All patients over 18 admitted to hospital should have VTE assessment completed.

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28
Q

What are 3 potential outcomes of a VTE assessment?

A

Low VTE risk- no prophylaxis
Significant VTE risk which outweighs risk of bleeding = prescribe LMWH
Significant VTW risk but with significant risk of bleeding e.g post-surgery= graduated compression stockings

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29
Q

Give 4 examples of when you might prescribe a ‘once only’ medication?

A

Drugs to be given stat
Pre-surgery single medication
Loading dose of medication given prior to prescribing daily maintenance dose
Vaccines

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30
Q

4 things you may consider when making prescriptions for chilldren?

A

Form- some children can’t take tablets/capsules
Route- IM usually avoided because painful
Timing- may need adapting around school day
Taste- important to children, influences adherence

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31
Q

In addition to the usual requirements e.g name, dose, strength etc. what extra information should you write in a prescription for a PRN drug?

A

maximum daily dose
maximum frequency of administration
minimum interval between doses

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32
Q

What class of drug is tiotropium and how does it work?

A

Long-acting anti-muscarinic bronchodilator

Inhibits PNS stimulation which usually causes bronchoconstriction

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33
Q

What type of drug is fluticasone and give a SE?

A

Inhaled corticosteroid

SE: oral thrush

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34
Q

Give 1st and 2nd line pharmacological treatment options for depression?

A 
1st= SSRIs e.g fluoxetine/citalopram 
2nd= TCAs (amitriptyline), alpha2 adrenoceptor antagonists (mirtazipine)

!!!May need checking (understand 2nd line)

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35
Q

Patient presents to hospital with status epilepticus.

What is 1st, 2nd and 3rd line management of this sitaution?

A 
1st= lorazepam 4mg slow IV (or diazepam)
2nd= If uncontrolled= add phenytoin / valproate 
3rd= If uncontrolled= anaesthetise, manage in CCU
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36
Q

What class of drug is Naproxen?

A

NSAID

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37
Q

Give 3 examples of dug classes which lower seizure threshold?

A

antidepressants, antipsychotics, opioids (particularly tramadol)

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38
Q

Cyclizine and Ondasentron are both what type of drugs? Give respective MOA.

A

Anti-emetics
Cyclizine= histamine 1 receptor anatagonist
Ondasentron= serotonin 5=HT3 receptor antagonist

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39
Q

Neuroleptic malignant syndrome is precipitated by drugs with what effect? Give examples

A

Anti-dopaminergic drugs
Phenothiazine antiemetic e.g. prochlorperazine, chlorperazine
Dopamine antagonist emetics e.g. metoclopromide
Antipschotics e.g, haloperidol

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40
Q

What type of bacteria is Helicobacter pylori?

A

Gram negative

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41
Q

What is the treatment for Helicobacter pylori peptic ulcer?

A

PAC (PPI, Amoxicillin, Clarithromycin)

If one of abx CI replace with metronidazole (must always be a triple therapy)

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42
Q

Loperamide is an opioid. What makes it different from other opioids? What is its MOA?

A

Does not cross BBB so no CNS effects (does not sedate)
Opioid U receptor agonist in myenteric plexus of GI tract therefore anti-motility drug
Prescribed in diarrhoea

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43
Q

Lactulose is an osmotic laxative. When would you prescribe lactulose?

A 
Hepatic encaphalopathy (regardless of constipation)
MOA: reduced absotption of ammonia by increasing speed of stool passage and acidifyingh stools therefore inhibiting proliferation of ammonia-producing bacteria
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44
Q

Give an example of a 1st and 2nd generation anti-histamine? What is their difference? Which would be better to prescribe for itch in liver disease?

A 
1st= chlorphenamine. SE- sedative. 
2nd= loratadine. X BBB so not sedative

Loratadine preferable for managing itch caused by liver disease as sedation can cause hepatic encephalopathy

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45
Q 
What are the adverse effects that the following drugs can have on the liver?
Flucloxacillin 
Paracteamol
Methotrexate 
Statin
A 
Flucloxacillin= rare SE choletatic jaundice 
Paracetamol= overdose- hepatoceullar necrosis 
Methotrexate= overdose/hypersensitivity reaction= hepatitis 
Statins= elevated transaminases, rare- drug-induced hepatitis
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46
Q

A patient currently on regular furosemide starts to develop hypokalaemia. Which medication change could resolve this?

A

Change to co-amilofruse (furosemide and amiloride- potassium sparing diuretic)

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47
Q

What serum K+ level defines severe hypokalaemia?

A

<2.5mmol/L

this warrants IV treatment

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48
Q

Give an example of an appropriate IV treatment for hypokalaemia and justify

A

KCl 20mmol/L in 1L Na+Cl- 0.9% given IV over 2 hours

IV potassium administration should not exceed 10mmol/hr

49
Q

What class of drug is oxybutinin and what is its indication?

A

Antimuscarinic (M3 receptor)

Overactive bladder

50
Q

Where are nicotinic receptors found?

A

Ach receptors found at NMJ in skeletal muscle

51
Q

Give 5 examples of drugs which can cause raised K+?

A 
Potassium supplements (oral/IV)
Aldosterone-receptor antagonist (spironolactone) 
Potassium-sparing diuretic (amiloride)
ACEi, 
ARB

(less significantly- aspirin , BBlocker)

52
Q

What class of drug is solifenacin? Indication? SEs?

A

Antimuscarinic
Urgency/Urge incontinence
SEs: dry mouth, blurred vision, constipation, confusion

(same as oxybutinin)

53
Q

Give 5 SEs of beta blockers

A 
Bronchospasm (CI WITH ASTHMA!)
ED 
Fatigue 
Headache 
GI upset
54
Q

Several antibiotics are cleared by the kidney and therefore patients with severe renal impairment required dose reduction to prevent complications.
Give an example of such a drug and it’s potential complication for the 3 classes below:
Penicillins
Tetracyclines
Aminoglycosides

A

Penicillins= benzylpenicillin/ co-amoxiclav
Comp- CNS toxicity, fits

Tetracyclines= doxycycline 
Comp= hepatotoxicity, nephrotoxicity 
Aminoglycosides= gentamicin 
Comp= ototoxicity, nephrotoxicity
55
Q

What is meant by FiO2?

A

Fraction of inspired oxygen, e.g air =0.21 (21% oxygen)

56
Q

What are the 2 broad categories of oxygen therapy? Give examples of each?

A

Controlled O2 therapy= venturi mask

Uncontrolled O2 therapy= nasal cannulae, simple face mask (rebreathe), non-rebreather+resevoir, AMBU bag

57
Q

When would you consider using a venturi mask?

A

Worried about patients with CO2 retention

When you need to know FiO2 delivered

58
Q

What are the 5 different levels of FiO2 oxygen delivery avaialble from a venturi mask?

A 
24%
28%
35%
40%
60%
59
Q

What is the consequence of under-prescribing oxygen?

A

Hypoxia- T1RF

60
Q

What is the consequence of over-prescribing oxygen?

A

In ptx with chronic hypercapnia, hypoxia is main respiratory driver. Giving O2 removes respiratory drive therefore causing T2RF.

61
Q

What might you see on ABG which may indicate that a patient is a chronic hypercapnic?

A

Raised HCO3-

62
Q

Which patients are at risk of T2RF if over-oxygenated?

A

COPD
NMJ disorder- MG
Drug overdoses- respiratory depressants e.g opiods/benzos
Severe chest deformity- kyphoscoliosis, ank spond

63
Q

What are the target ranges for oxygen sats:
Most patients
Ptx at risk of T2RF

A

Most patients: 94-98%

Risk of T2RF: 88-92%

64
Q

When might oxygen sats be falsely high?

A

Carbon monoxide poisoning

65
Q

Oxygen dissociates from oxyhaemoglobin more easily under what circumstances?

A

Increased temperature
Increased H+ (acidic)
Increased CO2

(therefore when tissues are hypoxic and therefore acidic, they receive oxygen more easily_

66
Q

Give 3 potential sites for ABG sampling?

A

Radial, brachial, femoral

67
Q

Give some indications for Long Term Oxygen Therapy (LTOT)?

A 
COPD
Pulmonary Hypertension 
Obstructive Sleep Apnoea
NMJ disorder 
Heart Failure 
Interstitial Lung Disease 
Lung Cancer
68
Q

What is the criteria for ABGs to warrant LTOT?

A

2 ABGs > 3 wks apart not less than 4 wks from exacerbation:

PO2<7.3 kPa
or
PO2 <8kPa + 2nd polycythaemia/ PH/ nocturnal hypoxaemia / peripheral oedema

69
Q

Give 3 forms of home oxygen therapy, purpose and a major risk to be aware of

A

Long term oxygen therapy- must be on >15hrs/day
Short-burst O2 therapy- intermittent O2 for exacerbations SOB
Ambulatory O2- O2 cylinder for ptx temporarily away from usual supply

Warning: major fire risk if ptx smokes around oxygen. Ptx should be non/ex smoker before considered for home O2

70
Q

Patient has a PE,
What investigation and oxygen should they receive?
!!

A

ABG

High flow O2

71
Q

Low flow through a non-rebreather turns it into…

A

a rebreather

72
Q

What is Senna and how does it work?

A

stimulant laxative

irritant to gut, increases water and electrolyte secretion from colon mucosa

73
Q

Give 3 examples of drugs that can precipitate gout?

A

Thiazide-like diuretics- reduces uric acid secretion by kidneys
Anti-cancer drugs - increased uric acid production with tumour breakdown
Low-dose aspirin

(alcohol too)

74
Q

What medication is given as long term prophylaxis for gout? MOA?

A

Allopurinol (xanthine oxidase inhibitor)

75
Q

MOA methotrexate?

A

Dihydrofolate reductase enzyme inhibitor
This enzyme usually converts folic acid to FH4

FH4 is required for DNA and protein synthesis

76
Q

Mx of methotrexate overdose/toxicity?

A

Folinic acid

Readily coverted to FH4 without the need for dihydrofolate reductase enzyme (which is inhibited by methotrexate)

77
Q

Which anticoagulant should be prescribed for…
VTE prophylaxis
Established VTE
Prevent arterial thromboembolism

A

VTE prophylaxis= LMWH e.g dalteparin 5000 units sc
Established VTE= warfarin/ DOAC
Prevent arterial thromboembolism= aspirin

78
Q

What is the difference between LMWH and unfractioned heparin? Give an indication for LMWH and a circumstance when you might use UF > LMWH?

A

Unfractioned heparin has shorter duration of activity,
LMWH have longer duration of activity

LMWH more widely used e.g prevention and treatment of DVT/PE
UF used if high risk of bleeding as effects can be terminated rapidly by stopping infusion

UF > LMWH in renal impairment

(BNF- parenteral anticoagulants-2021)

79
Q

What class of drug is cefotaxime?

A

cephalospirn

80
Q

Warfarin is metabolised by CYp450 enzyme. Give an example of a seizure medication that induces and one that inhibits CYP450 and what the resultant effect on prescribing with warfarin is?

A

Carbamazepine= CYP450 inducer
Increases warfarin metabolism, lower levels of warfarin, greater chance of clotting, lower INR

Valproate= CYP450 inhibitor
Decreases warfarin metabolism, more warfarin, greater chance of bleeding, higher INR

81
Q

3 medications which can be used first line for uncomplicated UTI and when CI?

A

Trimethoprim- CI first trimester pregnancy
Nitrofurantoin- CI latter stages pregnancy
Amoxicillin

82
Q

Medication which can be used 2nd line uncomplicated / 1st line complicated UTI?

A

ciprofloxacin

83
Q

What class of drug is ciprofloxacin?

A

quinolone

84
Q

2 common bacterial causes of skin/soft tissue infections? 2 antibiotics which may be given?

A

Skin/soft tissue infection:
Staph aureus, group A strep (strep pyogenes)

Abx- benzylpenicillin, flucloxacillin

85
Q

Name a penicillinase resistant abx

A

Flucloxacillin

86
Q

2 abx given in management of severe penumonia

A

amoxicillin and clarithormycin (cover typical and atypical microbes respectively)

87
Q

Patient has an intracranial infection. Pending LP diagnosis which 2 medications should be given?

A

Cefotaxime- ?bacterial meningitis

Acyclovir- ?viral encephalitis

88
Q

Patient has suspected intra-abdominal sepsis, which 2 abx should be prescribed?

A

Metronidazole and co-amoxiclav (covers anaerobic and gram neg aerobic organisms respectively)

89
Q

What are the components of co-amoxiclav?

A

Amoxicillin and clavulonic acid

90
Q

Gove a gram positive and gram negative cause of community acquired pneumonia?

A

Gram + strep pneumoniae

Gram - haemophilus influenzae

91
Q

Why might prescribing doxycycline be sensible for unknown cause of community acquired pneumonia?

A

Doxycycline covers gram +, gram - and atypical bacteria

92
Q

Which bacteria is flucloxacillin most effective against?

A

Staph aureus

93
Q

In what circumstances might you prescribe vancomycin?

A

infections resistant to penicillins e.g MRSA

C.Diff if recurrent or metronidazole CI

94
Q

Give 2 examples of antibiotic that may cause ototoxicity and their associated class?

A

Gentamicin, vancomycin,
Glycopeptide abx

(note that the similar named azithomycin/clarithromycin etc. are macrolides)

95
Q

What is a potential side effect of tetracyclines and hence who should they not be prescribed to?

A

Bind to calcium in developing teeth/bones causi discolouration and hypoplasia of tooth enamel/developing skeleton
CI- pregnancy, breast feeding, children <12

96
Q

What is QT? What is prolonged QT time? Give 4 drugs which cause prolonged QT?

A 
QT= beginning of Q to end of T (time for ventricles to repolarise)
Prolonged= >0.44 (M), >0.46 (F)
Drugs= antiarrhythitic (amiodarone), antipsychotics (haloperidol), macrolides (clarithromycin), quinnine
97
Q

Gentamicin, Vancomycin and Clarithromycin should all be given as slow IV infusions.
If they are given as bolus what happens?

A

Gentamicin- ototoxicity
Vancomycin- anaphylactoid reaction
Clarithromycin- phlebitis/arrythmia

98
Q

What is phlebitis?

A

Inflammation of a vein

99
Q

What is an anaphylactoid reaction- sx? How is it different to anaphylaxis?

A

Histamine mediated reaction, sx include urticaria, angiodema, bronchospasm
Unlike anaphylais it does not involve IgE antibodies

100
Q

What are maintenance water, Na+, K+ requirements?

A

Water 30ml/kg/day
Na+ 1mmol/kg/day
K+ 1mmol/kg/day

101
Q

What is an appropriate fluid choice for fluid resuscitation?

A

NaCl 0.9% 500ml over 10mins IV

Concentration of Na+ similar to that in ECF so is retained in ECF. After distribution ~20% remains in circulation.

102
Q

What is another name for Hartmanns solution?

A

Compound sodium lactate

103
Q

Hartmanns is a good option for fluid resuscitation, give the quantity, route and time for this?
Which patients is it inappropriate for and why?

A

250/500ml IV over 15 mins

Contains K+ (balanced salt solution), so don’t give to ptx with hyperkalaemia/anuria

104
Q

Glucose 5% is good for fluid replacement but bad for fluid resuscitation, why?

A

Distributes throughout the entire body leaving only 7% in circulation

105
Q

Human albumin solution is a colloid solution. Why is it not often used?

A

Little evidence to suggest colloids > crystalloids
More expensive
Not usually stocked on general wards

106
Q

What is an appropriate crystalloid / colloid fluid challenge?
Name 2 possible solutions, quantity, route, time?

A

Crystalloid:
0.9% NaCl / Hartmann’s
250-500ml IV over 15 mins

Colloid:
Human albumin solution / synthetic colloid
100-250ml IV over 15 mins

107
Q

What is pethidine and when is it typically given?

A

Opiate analgesia, given IM

particularly given during childbirth

108
Q

Flumazenil reverses the action of which drug?

A

Benzodiazepines

109
Q

Name a rapid acting insulin?

A

Novorapid

act-rapid is short-acting

110
Q

Name a short-acting insulin

A

Actrapid

111
Q

Name a long-acting insulin

A

Insulin detemir / Insulin glargine

112
Q

Most insulins are manufactured to what unit/ml strength?

A

100 units/ml

113
Q

Patient glucose recordings indicate that they experience hyperglycaemia overnight and in morning but have better daytime control, what kind of insulin regimen is appropriate in this specific case?

A

Intermediate-acting insulin given at night before bed

114
Q

Describe what a basal-bolus insulin regimen involves?

A

Intermediate/long-acting basal insulin to deliver constant insulin throughout the day, short-acting insulin bolus injections before each meal

115
Q

What is an advantage of basal-bolus insulin regimen?

A

Mimics normal pattern of insulin production

More flexibility over meal times

116
Q

What is a disadvantage of a basal-bolus insulin regimen?

A

More injections, more monitoring throughout day

117
Q

What are the indications for giving a continous SC insulin infusion pump?

A

T1DM >12yo
Ptx experiencing disabling hypos from trying to achieve target HbA1c
HbA1c >61 despite daily injection and good level of care

118
Q

What should be present on an insulin prescription?

A

Date,
Route (IV/SC)
Name- brand and generic in full + “insulin”

SC- dose, units, administration device
IV- rate of administration

Always write “units” in full

119
Q

What equipment should you prescribe for diabetes patients

A

Monitoring:
Lancet for finger pricking
Blood testing meter (GP / DM clinic only)

Treating:
Syringe if insulin in vials
Injection pens + needles + needle clipping device
Sharps bin

Maud- Phase 3b (14 decks)

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