Pharmacology (things I forget)

Question 1

What is a common endocrine side effect of lithium?

Answer 1

Chronic lithium toxicity –> hypothyroidism

Question 2

What electrolyte imbalance is associated with SSRIs?

Answer 2

Hyponatraemia

Question 3

What are symptoms of SSRI discontinuation syndrome?

Answer 3

• Dizziness
• GI symptoms (diarrhoea)
• Electric shock sensations
• Anxiety

Question 4

What increased risk is associated with atypical antipsychotics?

Answer 4

Stroke/VTE in elderly

Question 5

Which SSRI is most likely to cause cardiac anomalies?

Answer 5

Citalopram - QT prolongation and Torsades de Pointes

Question 6

What medications are prescribed to patients with HTN?

Answer 6

T2DM = ACEi/ARB e.g. ramipril/losartan

<55 = ACEi/ARB

> 55 = CCB e.g. amlodipine

Black African/African–Caribbean origin = CCB

CCB not tolerated = thiazide-like diuretic e.g. indapamide

Still not effective (resistant HTN) = check compliance/more readings/spironolactone (if low potassium - U&Es before and 2 weeks after/within 1 month)/beta blocker

Question 7

What is the guidance for anticoagulants in pregnancy?

Answer 7

Switch DOACs e.g. apixaban, edoxaban to LMWH e.g. enoxaparin, dalteparin

Question 8

What is a common drug used for pain in palliative care?

Answer 8

Diamorphine

Question 9

What is a common drug used for distress/agitation in palliative care?

Answer 9

Midazolam

Question 10

What is a common drug used for breathlessness in palliative care?

Answer 10

Midazolam

Question 11

What is a common drug used for respiratory tract secretions/bowel spasms in palliative care?

Answer 11

Buscopan (hyoscine butylbromide)

Question 12

What is a common drug used for nausea and vomiting in palliative care?

Answer 12

Haloperidol

Question 13

What is the mechanism of action of aspirin?

Answer 13

COX-1 receptor inhibitor

Question 14

What is the mechanism of action of clopidogrel?

Answer 14

P2Y12 inhibitor

Question 15

What is the mechanism of action of allopurinol?

Answer 15

Xanthine oxidase inhibitor

Question 16

What is the mechanism of action of carbamazepine?

Answer 16

Modulates sodium and calcium channels in CNS

Question 17

What is the mechanism of action of N-acetylcysteine?

Answer 17

Replenishes body stores of glutathione (needed to detoxify toxic product of paracetamol metabolism)

Question 18

What is the mechanism of action of methotrexate?

Answer 18

Competitively inhibits dihydrofolate reductase

Question 19

What is the mechanism of action of caffeine?

Answer 19

Blocks adenosine receptors

Question 20

What is used in DOAC overdose?

Answer 20

Beriplex - contains vitamin K-dependent clotting factors (10, 9, 7, 2)

Dabigatran - idarucizumab

Question 21

What is used in warfarin overdose?

Answer 21

Vitamin K +/- beriplex (if significant haemorrhage)

Question 22

What is used in heparin overdose?

Answer 22

Protamine

Question 23

What is the mechanism of action of benzodiazepines?

Answer 23

Facilitate and enhance binding of GABA to GABA receptors

Question 24

What is the mechanism of action of antipsychotics?

Answer 24

Block postsynaptic dopamine D2 receptors

Question 25

What is the mechanism of action for hydroxycarbamide?

Answer 25

A.k.a hydroxyurea

Cytotoxic drug - myelosupression (decreases BM activity –> fewer RBCs/WBCs/platelets)

Question 26

Which medications can cause Stevens-Johnson syndrome?

Answer 26

• Allopurinol
• Lamotrigine/carbamazepine/phenytoin
• NSAIDs
• Oral contraceptive pill
• Penicillin
• Sulphonamides

Question 27

What is the mechanism of action of SGLT-2 inhibitors?

Answer 27

E.g. empagliflozin

Increase urinary glucose excretion

Question 28

What is the mechanism of action of sulfonoylureas?

Answer 28

E.g. gliclazide

Increase insulin release from pancreas

Question 29

What medication CANNOT be taken alongside methotrexate?

Answer 29

Trimethoprim