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MSRA > Pharmacology/Therapeutics 2 > Flashcards

Pharmacology/Therapeutics 2 Flashcards

1
Q

SE ACE inhibitors (2)
What blood tests for monitoring? and how often?
What percentage increase in creatinine is acceptable

A

Cough
•Hyperkalaemia

check U&E before starting and after increase in dose. Can allow up to 30% increase in creatinine rise or potassium up to 5.5

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2
Q

SE Bendroflumethiazide (4)

A

• Gout
• Hypokalaemia
• Hyponatraemia
• Impaired glucose tolerance

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3
Q

SE Beta-blockers (4)

CI (3)

A

•Bronchospasm (especially in asthmatics)
Cold peripheries
Sleep disturbances
Erectile dysfunction

CI uncontrolled heart failure, asthma, sick sinus syndrome

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4
Q

SE Doxazosin (1)

A

postural hypotension

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5
Q

nitrates SE (3)

A

Headache
•Postural hypotension
•Tachycardia

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6
Q 
Nicorandil SE (3)
CI (1)
A

Headache
•Flushing
•Anal ulceration
CI left ventricular failure

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7
Q

Drugs that can cause impaired glucose tolerance (7)

A
  1. thiazides, furosemide (less common)
  2. steroids
  3. tacrolimus, ciclosporin
  4. interferon-alpha
  5. nicotinic acid
  6. antipsychotics
  7. BBs
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8
Q

Drugs causing lung fibrosis (5)

A
  1. amiodarone
  2. cytotoxic agents: busulphan, bleomycin
  3. anti-rheumatoid drugs: methotrexate, sulfasalazine
  4. nitrofurantoin
  5. ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
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9
Q

Drugs causing optic neuritis (3)

A

ethambutol
amiodarone
metronidazole

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10
Q

drugs causing Corneal opacities (2)

A

amiodarone

indomethacin

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11
Q

Drugs causing Retinopathy (2)

A

chloroquine, quinine

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12
Q

What can cause both blue discolouration and non-arteritic anterior ischaemic neuropathy?

A

Sildenafil

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13
Q

Drugs causing photosensitivity (5)

A
  1. thiazides
  2. tetracyclines, sulphonamides, ciprofloxacin
  3. amiodarone
  4. NSAIDs
  5. sulphonylureas
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14
Q 
Ecstasy poisoning
Features: 
Neuro (4) 
Cardio (2) 
Other (3)

Mx

A
  1. neurological: agitation, anxiety, confusion, ataxia
  2. cardiovascular: tachycardia, hypertension
  3. hyponatraemia
  4. hyperthermia
  5. rhabdomyolysis

Mx supportive, dantrolene for hypothermia

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15
Q

Lithium toxicity can be precipitated by?

A
  1. dehydration
  2. renal failure
  3. diuretics (especially thiazides)
  4. ACE inhibitors/angiotensin II receptor blockers
  5. NSAIDs
  6. metronidazole.
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16
Q

Lithium toxicity features (6)

A 
coarse tremor (a fine tremor is seen in therapeutic levels)
hyper reflexia
acute confusion
polyuria
seizure
coma
17
Q

mixed respiratory alkalosis and metabolic acidosis can be seen in what overdose?

A

Salicyclate

18
Q 
Overdose in what can cause these symptoms? 
hyperventilation (centrally stimulates respiration)
tinnitus
lethargy
sweating, pyrexia*
nausea/vomiting
hyperglycaemia and hypoglycaemia
seizures
coma
A

Salicyclate overdose features (8)

19
Q

Breastfeeding
Contraindicated
Safe

A 
CI 
cipro
chloramphenicol
sulphonamides
tetracycline
lithium 
benzos
aspirin 
carbimazole 
MTX
sulfonyureas
amiodarone 
cyototoxic drugs
clozapine 
Safe 
penicillins
cephalosporins
trimethroprim
steroids
thyroxine
TCAs
antipsychotics
BBS
hydralazine 
warfarin 
heparin 
digoxin 
theophylines
20
Q

Drugs to avoid in renal failure

A 
tetracycline
nitrofurantoin
NSAIDs
lithium
metformin
21
Q

Medications which might exacerbate heart failure

A
  1. Verapamil
  2. Antiarrythmics e.g flecainide
  3. Pioglitazone
  4. NSAIDs
  5. Steroids
22
Q

What poisoning?

Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation

Mx

A

Organophosphate insecticide poisoning

atropine

23
Q

Sildenafil CI (3)

A

taking nitrates or CCB e.g nicorandil
hypotension
stroke or myocardial infarction within last 6 months

24
Q

Sildenafil SE (5)

A

visual disturbances e.g. blue discolouration
non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
headache

25
Q 
Cocaine 
Adverse effects 
Heart (5) 
Neuro (4)
Psych (3) 
Other (4) - hints, hot or cold, metabolic acidosis or alkalosis, what can happen to the kidney, and the abdomen
A 
myocardial infarction
both tachycardia and bradycardia may occur
hypertension
QRS widening and QT prolongation
aortic dissection

seizures
mydriasis
hypertonia
hyperreflexia

agitation
psychosis
hallucinations

ischaemic colitis
hyperthermia
metabolic acidosis
rhabdomyolysis

26
Q

Cocaine toxicity mx

A
  1. benzodiazepines
    If CP + GTN
    If HTN + sodium nitroprusside
27
Q

Digoxin toxicity
When to measure levels?

Features (5)

Mx (3)

A

If suspected toxicity measure 8-12hrs post dose

generally unwell
lethargy, nausea & vomiting, anorexia, confusion
yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

Digibind
correct arrhythmias
monitor potassium

28
Q

Digoxin toxicity

Name the classical precipitating factor for toxicity

A

classically: hypokalaemia

29
Q 
Dopamine receptor agonists
Adverse effects (4)
A

nausea/vomiting
postural hypotension
hallucinations
daytime somnolence

30
Q

Mefloquine
Used in?
Adverse effects
CI

A

Anti-malarial
neuropsychiatric e.g nightmares, anxiety, suicidal

mefloquine should not be used in patients with a history of anxiety, depression schizophrenia or other psychiatric disorders

31
Q

Metformin CI (4)

A
  1. CKD
    dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)
  2. Recent myocardial infarction, sepsis, acute kidney injury and severe dehydration due to risk of lactic acidosis
  3. contrast imaging
    - should be discontinued on the day of the procedure and for 48 hours thereafter
  4. alcohol abuse is a relative contraindication
32
Q

1st line treatment in opioid detoxification

How is compliance monitored?

A

methadone or buprenorphine

compliance is monitored using urinalysis

MSRA (22 decks)

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