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MRCP Part 1 > Pharmacology & Toxicology > Flashcards

Pharmacology & Toxicology Flashcards

1
Q

Causes of Hyperpyrexia (7)

A
  1. Salicylates *
  2. Ecstasy *
  3. Cocaine *
  4. Neuroleptic malignant syndrome
  5. Serotonin syndrome
  6. Thyroid storm
  7. Co poisoning *
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2
Q

3 Drugs casuse sensorineural deafness

A
  1. Lasix iv ( oral unlikely)
  2. Vancomycin iv
  3. Erythromycin iv
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3
Q

6 Drug induced impaired glucose tolerance

A
  1. Nicotinic acid ( Vit B3)
  2. Atypical antipsychotics ( olanzapine )
  3. Tacrolimus & cyclosporine
  4. Steroids
  5. Interferon alpha
  6. Thiazides & lasix

*NAT SIT

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4
Q

4 Drug causes of urticaria

A
  1. NSAIDS
  2. Opiates
  3. Penicillins
  4. ASA
  • NOPA
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5
Q

7 Drugs causing photosensitivity

A
  1. NSAIDS
  2. ACEi/ ARBs
  3. Sulfphonylureas
  4. Thiazides
  5. Amiodarone
  6. Psoralens
  7. Tetracycline, sulphonamide, cipro
  • NAS TAPT
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6
Q

3 Drug causes of gingival hyperplasia

A
  1. Cyclosporine
  2. Phenytoin
  3. CCB ( especially Nifedipine)

*CPC

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7
Q

5 Drug causing lung fibrosis

A
  1. Amiodarone
  2. Methotrexate & sulfasalazine
  3. Bleomycin & busulphan
  4. Nitrofurantoin
  5. Bromocriptine , cabergoline, pergolide
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8
Q

5 Drug induced urinary retention

A
  1. Disopyramide
  2. Opioids
  3. Tricyclic antidepressants
  4. Anticholinergics ( antipsychotics & antihistamine)
  5. NSAIDS
  • DO TAN
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9
Q

Drug induced pancytopenia

A
  1. Cytotoxics
  2. Antibiotics: trimethoprim, chloramphenicol
  3. Anti-rheumatic: Gold , penicillamine
  4. Carbimazole
  5. Phenytoin, carbamazepine
  6. Sulphonylureas
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10
Q

Drug causes of agranulocytosis

A
  1. Antithyroid drugs - carbimazole, propylthiouracil

2.Antipsychotics - atypical antipsychotics (CLOZAPINE)

3.Antiepileptics - carbamazepine

4.Antibiotics - penicillin, chloramphenicol, co-trimoxazole

5.Antidepressant - mirtazapine

6.Cytotoxic drugs - methotrexat

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11
Q

1 Drugs causing Cataracts

A

steroids

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12
Q

2 Drugs causing Corneal opacities

A

amiodarone
indomethacin

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13
Q

3 Drugs causing Optic neuritis

A

amiodarone

ethambutol

metronidazole

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14
Q

Drugs causing Retinopathy

A

chloroquine, quinine

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15
Q

Drugs causing blue discolouration and non-arteritic anterior ischaemic neuropathy

A

Sildenafil

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16
Q

Alcohol drinking management

A

Ora thiamine

Benzodiazepines for acute withdrawal

Disulfram

Acamprosate

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17
Q

Stages of Ethylene toxicity

A

Stage 1: symptoms similar to alcohol intoxication: confusion, dizziness, dysarthria

Stage 2: metabolic acidosis, high Anion Gap & high osmolar gap, tachycardia, HTN

Stage 3: AKI

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18
Q

Treatment of ethylene toxicity

A
  • fomepizole is preferred to ethanol
  • hemodialysis
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19
Q

Treatment of Methanol poisoning

A
  • fomepizole
  • hemodialysis
  • cofactor therapy with folinic acid to reduce ophthalmological complications
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20
Q

Ecstasy poisoning features

A

CNS: agitation, confusion , ataxia

CVS: tachycardia and HTN

Fever

Hypo Na

Rhabdomyolsis

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21
Q

Ecstasy poisoning management

A
  • supportive
  • dantrolene maybe used for fever if other simple measures fail
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22
Q

Carboxyhemoglobin level in non smoker

A

< 3 %

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23
Q

Carboxyhemoglobin level in smoker

A

< 10 %

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24
Q

Carboxyhemoglobin level in symptomatic

A

10-30 %

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25
Q

Carboxyhemoglobin level in severe toxicity

A

> 30 %

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26
Q

in Carbon monoxide poisoning , ECG is useful to look for …..

A

Cardiac ischemia

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27
Q

Treatment of CO poisoning

A
  • 100 % high flow O2 via Non rebreather mask
  • Minimum 6 hrs
  • Target SPo2 100 %
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28
Q

5 Indication of hyperbaric oxygen in CO poisoning

A
  1. Level > 25 %
  2. Pregnancy
  3. Neurological signs
  4. Myocardial ischemia
  5. Arrhythmia
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29
Q

5 Features of Mercury poisoning

A
  1. Visual field defects
  2. Hearing loss
  3. Irritability
  4. Paraesthesia
  5. RTA
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30
Q

2 Risk factors of Paracetamol overdose

A
  1. Malnourished patients ( e.g anorexia nervosa) or patients who have not eaten for a few days
  2. Hepatotoxic Drugs ( rifampicin, phenytoin, carbamazepine, chronic alcohol excess

** acute alcohol intake is not risk factor
** maybe protective

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31
Q

Acetyl cysteine is used in ttt of paracetamol overdose as it’s …….

A

It’s a precursor of glutathione and hence can increase hepatic glutathione production

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32
Q

Side effect of acetylcysteine ?
And how to treat?

A

Anaphylactoid reaction

  • stop iv acetyl cysteine then restarting at slower rate
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33
Q

Criteria for liver transplant in paracetamol liver failure

A
  1. PH < 7.3 , 24 hrs after ingestion

Or

  1. PT > 100 sec & creat > 300 & encephalopathy grade III or IV
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34
Q

Paracetamol overdose occurs when glutathione stores run out leading to ….

A

Increase NAPQI ( N acetyl p benzoquinone imine)

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35
Q

Fomepizole is an inhibitor of ….

A

Alcohol dehydrogenase

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36
Q

Confusion and pink mucosae

A

CO poisoning

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37
Q

Features of organophosphate poisoning

A

Salivation
Lacrimation
Urination
Defecation
Hypotension
Bradycardia
Small pupils
Muscle fasciculation

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38
Q

Drugs that can be cleared with hemodialysis

A

BLAST

  1. Barbiturates
  2. Lithium
  3. Alcohol ( methanol & ethylene glycol)
  4. Salicylate
  5. Theophylline ( charcoal hemoperfusion is preferred)
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39
Q

Drugs that can ( not ) be cleared with hemodialysis

A
  1. Tricyclics & benzodiazepines
  2. BB & digoxin
  3. Dextropropoxyphene
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40
Q

BB overdose features & treatment

A

Hypotension
Bradycardia
HF
Syncope

Ttt:
If bradycardia&raquo_space; >atropine
In resistant cases&raquo_space;> glucagon

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41
Q

Treatment of organophosphate poisoning

A
  • Atropine
  • pralidoxime
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42
Q

Salicylate overdose features

A
  1. Mixed respiratory alkalosis and metabolic acidosis
  2. Hyperventilation
  3. Seizures and coma
  4. Sweating and fever
  5. Hyperglycemia and hypoglycemia
  6. Tinnitus and lethargy
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43
Q

Salicylate overdose treatment

A
  • ABC
  • Charcoal
  • Urinary alkalinization with iv NaHco3
  • Hemodialysis
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44
Q

6 Indications for hemodialysis in Salicylate overdose

A
  1. Serum concentration > 700 mg/l
  2. Persistent metabolic acidosis
  3. AKI
  4. Pulmonary edema
  5. Seizures
  6. Coma
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45
Q

Cyanide poisoning features

A

Classical features: Brick red skin & Smell of bitter almonds

Acute : hypoxia , hypotension, headache, confusion

Chronic: ataxia, peripheral neuropathy, dermatitis

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46
Q

Cyanide poisoning management

A
  • 100 % O2
  • Iv hydroxocobalamin
  • combination of amyl nitrite , Na nitrite and Na thiosulfate
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47
Q

Botulinum toxin indications

A
  1. Achalasia
  2. Severe hyperhidrosis of the axillae
  3. Hemifacial spasm
  4. Blepharospasm
  5. Spasmodic torticollis
  6. Focal spasticity in cerebral palsy, hand& wrist disability associated with stroke
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48
Q

When should measure digoxin level If suspected digoxin toxicity

A

Within 8 -12 hrs of the last dose

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49
Q

Features of digoxin toxicity

A

Lethargy, confusion

Nausea and vomiting and anorexia

AV block , bradycardia

Gynecomastia

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50
Q

Precipitating factors for digoxin toxicity

A
  • Hypo K , Hypo Mg , Hypoalbuminaemia
  • hypothermia, hypothyroidism
  • hyper Ca , Hyper Na
  • renal failure, acidosis
  • myocardial ischemia
  • old age
  • drugs
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51
Q

Precipitating factors for digoxin toxicity
( drugs )

A
  • amiodarone, Verapamil, diltilazem
  • quinidine
  • ciclosporin , spironolactone
  • drugs can cause Hypo K: thiazides, loop diuretics
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52
Q

Management of digoxin toxicity

A
  1. Digibind
  2. Correct arrhythmias
  3. Monitor potassium
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53
Q

Treatment of lead toxicity

A

Dimercaprol , Ca edetate

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54
Q

Treatment of benzodiazepines overdose

A
  1. Supportive care
  2. Flumazenil ( can cause seizure) only with severe or iatrogenic overdose
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55
Q

Lithium toxicity occurs when the concentration level

A

> 1.5 mmol/L

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56
Q

Lithium toxicity maybe precipitated by

A

Dehydration

Renal failure

Drugs: thiazides, ACEi/ARBs , NSAIDS, Flagyl

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57
Q

Features of lithium toxicity

A
  1. Coarse tremor ( fine tremor in therapeutic level )
  2. Hyperreflexia
  3. Confusion , seizure , coma
  4. Polyuria
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58
Q

Cocaine mechanism of action

A

Cocaine block the uptake of dopamine, noradrenaline and serotonin

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59
Q

Treatment of cocaine toxicity

A
  • benzodiazepines first line
  • chest pain: benzodiazepines + glyceryl trinitrate, if MI&raquo_space; PCI
  • HTN : benzodiazepines + Na nitroprusside
  • BB in cocaine induced cardiovascular problems
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60
Q

Early features of tricyclic overdose

A
  • Dry mouth
  • dilated pupils , blurred vision
  • agitation
  • sinus tachycardia
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61
Q

4 features of severe poisoning in
tricyclic overdose

A
  • seizures,
  • coma
  • metabolic acidosis
  • arrhythmias
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62
Q

ECG changes in tricyclic overdose

A
  • sinus tachycardia
  • widening of QRS
  • Prolongation of QT interval
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63
Q

In tricyclic overdose , Widening of QRS

  1. > 100 associated with …….
  2. > 160 associated with ……
A

I. Seizures

  1. VT
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64
Q

Treatment of tricyclic overdose

A
  1. IV bicarbonate
    - first-line therapy for hypotension or arrhythmias
  • indications include widening of the QRS interval >100 msec or a ventricular arrhythmia
  1. other drugs for arrhythmias
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65
Q

CCB side effects

A
  • Headache
  • • Flushing
    • - Ankle oedema
  • Verapamil also commonly causes constipation
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66
Q

BB side effects

A
  • Bronchospasm (especially in asthmatics)
    •
  • Fatigue

-• Cold peripheries

-• Sleep disturbances

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67
Q

Nítrates side effects

A
  • Headache
  • • Postural hypotension

• - Tachycardia

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68
Q

Nicorandil side effects

A
  • Headache
  • • Flushing

-• Anal ulceration

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69
Q

Drug causing yellow green tinge in vision

A

Digoxin

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70
Q

Classical hallmark of Quinine toxicity
(cinchonism)

A
  • Tinnitus, visual blurring
  • dry skin
  • arrhythmias
  • pulmonary edema
  • abdominal pain
  • hypoglycemia
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71
Q

Arrhythmias in Quinine toxicity due to…

A

Blockade of Na & K channels prolonging QRS & QT interval and these generate into ventricular tachyarrythmias or fibrillation causing death.

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72
Q

Hypoglycemia in Quinine toxicity due to

A

Quinine stimulates pancreatic insulin secretion

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73
Q

Quinine toxicity vs Aspirin poisoning

A

Difficult to distinguish so measure salicylate levels is important

  • tinnitus & deafness & visual defects are transient with Aspirin

But permanent with quinine

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74
Q

Management of Quinine toxicity

A
  • supportive with fluids , Inotropes
  • bicarbonate as needed
  • positive pressure ventilation for pulmonary edema
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75
Q

Iron tables overdose features

A
  • Hypotension
  • Abdominal pain
  • Coffee ground vomiting & black stool
  • metabolic alkalosis 2ry to vomiting
  • iron table radio-plaque in X-ray or CT
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76
Q

Treatment of Iron tables overdose

A
  • Gastric lavage with desferrioxamine into stomach to reduce further iron absorption
  • iv desferrioxamine at rate 15 mg/kg/hr is an initial ttt of choice and it’s important to start with it as soon as possible
  • hemodialysis
  • plasma exchange
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77
Q

Ethambutol inhibits

A

the enzyme arabinosyl transferase which polymerizes arabinose into arabinan

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78
Q

Pyrazinamide converted by pyrazinamidase into ….

A

converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I

79
Q

Which anti TB can cause gout ?

A

Pyrazinamide

80
Q

Isoniazid inhibits …….

A

inhibits mycolic acid synthesis

81
Q

Rifampicin inhibits …….

A

inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA

82
Q

Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:

A

adjustment of phenytoin dose

suspected toxicity

detection of non-adherence to the prescribed medication

83
Q

Tacrolimus is acalcineurin inhibitor
decreases clonal proliferation of T cells by …..

A

reducing IL-2 release

84
Q

Which one of diabetes drugs can cause fluid retention

A

Glitazones

85
Q

Which one of diabetes drugs can cause SIADH

A

Sulfonylureas

86
Q

neuromuscular excitation

hyperreflexia

myoclonus

rigidity

autonomic nervous system excitation

hyperthermia

sweating

altered mental state

confusion

Features of……..?

A

Serotonin syndrome

87
Q

Side effects of Quinolones

A
  1. lengthens QT interval
  2. tendon damage
  3. Cartilage damage
  4. lower seizure threshold
88
Q

Contraindications of Quinolones

A

avoid inG6PD

Pregnancy

Breastfeeding

89
Q

Amiloride blocks …..

A

the epithelial sodium channel in the distal convoluted tubule

90
Q

Side-effects of PDE5 inhibitors

A

visual disturbances

blue discolouration

non-arteritic anterior ischaemic neuropathy

nasal congestion

flushing

gastrointestinal side-effects

headache

priapism

91
Q

Features of oculogyric crisis

A

restlessness, agitation

involuntary upward deviation of the eyes

92
Q

Causes of oculogyric crisis

A

antipsychotics

metoclopramide

postencephalitic Parkinson’s disease

93
Q

Management of oculogyric crisis

A

cessation of causative medication if possible

Iv antimuscarinic:benztropine or procyclidine

94
Q

somatostatin is released from …..1….

and inhibits …..2…….

A
  1. D cells of pancreas
  2. the release of growth hormone, glucagon and insulin
95
Q

Side effects of Octreotide

A

gallstones (secondary to biliary stasis)

96
Q

Management of Motion sickness

A
  1. transdermal patch hyoscine
  2. non-sedating antihistamines such as cyclizine or cinnarizine are recommended in preference to sedating preparation such as promethazine
97
Q

Mechanism of action of Metformin

A

acts byactivation of the AMP-activated protein kinase (AMPK)

increases insulin sensitivity

decreases hepatic gluconeogenesis

may also reduce gastrointestinal absorption of carbohydrates

98
Q

Metformin should be stopped if
1. creatinine
Or
2. eGFR

A
  1. > 150
  2. GFR < 30
99
Q

Half life of iv Ig

A

3 weeks

100
Q

Gentamicin can cause nephrotoxicity secondary to……

A

secondary to acute tubular necrosis

101
Q

HMG CoA reductase inhibitors ?

A

Statins

102
Q

Decreases cholesterol absorption in the small intestine?

A

Ezetimibe

103
Q

Decreases hepatic VLDL secretion?

A

Nicotinic acid

104
Q

Agonist of PPAR-alpha therefore increases lipoprotein lipase expressionMyositis, pruritus ?

A

Fibrates

105
Q

Decreases bile acid reabsorption in the small intestine, upregulating the amount of cholesterol that is converted to bile acid ?

A

Cholestyramine

106
Q

Activates antithrombin III. Forms a complex that inhibits thrombin, factors Xa, IXa, Xia and XIIa

Which drug ?

A

Heparin

107
Q

Activates antithrombin III. Forms a complex that inhibits factor Xa
Which drug ?

A

LMWH

108
Q

Heparin-induced thrombocytopaenia (HIT) is immune mediated -antibodies form against ……

A

complexes of platelet factor 4 (PF4) and heparin

109
Q

Finasteride is an inhibitor of……

A

5 alpha-reductase, an enzyme which metabolises testosterone into dihydrotestosterone.

110
Q

Indications for Finasteride

A

benign prostatic hyperplasia

male-pattern baldness

111
Q

Finasteride & serum prostate-specific antigen

A

Finasteride causes decreased levels of serum prostate-specific antigen

112
Q

sumatriptan is ….

A

a 5-HT1D receptor agonist

113
Q

pizotifen & Methysergide & cyproheptadine are

A

a 5-HT2 receptor antagonist

114
Q

extensive skin rash, high fever, and organ involvement,
Eosinophilia a and abnormal liver function tests.

Features of….?

A

DRESS

115
Q

the diagnosis of DRESS syndrome conformed by …

A

Skin biopsy

116
Q

DRESS syndrome treatment

A

all medications that are a possible culprits to be stopped and supportive care started.

Antihistamines, topical steroids

Systemic steroids may be started in severe cases where exfoliative dermatitis / pneumonitis / hepatitis is present.

Occasionally immunosuppressants, intravenous immunoglobulin and plasmapheresis may be started

117
Q

ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide*) have been associated with

A

pulmonary, retroperitoneal and cardiac fibrosis.

118
Q

4 Indications of dopamine receptor agonists

A

Parkinson’s disease

prolactinoma/galactorrhoea

cyclical breast disease

acromegaly

119
Q

4 Side effects of dopamine receptor agonists

A

nausea/vomiting

postural hypotension

hallucinations

daytime somnolence

120
Q

Ciclosporin is an immunosuppressant which decreases clonal proliferation of T cells by…….

A

reducing IL-2 release

121
Q

Ciclosporin acts by binding to cyclophilin forming a complex whichinhibits …….

A

calcineurin

122
Q

11 Adverse effects of ciclosporin

A
  1. Nephrotoxicity
  2. Hepatotoxicity
  3. HTN
  4. Fluid retention
  5. impaired glucose tolerance
  6. hyperlipidaemia
  7. Hyperkalaemia
  8. Tremor
  9. gingival hyperplasia
  10. increased susceptibility to severe infection
  11. hypertrichosis ( excessive hair growth)
123
Q

ciclosporin & cannabidiol

A

cannabidiol: may increase the concentration of ciclosporin

124
Q

Allopurinol is

A

xanthine oxidase inhibitor

125
Q

Patients at a high risk of severe cutaneous adverse reaction of allopurinol should be screened for

A

HLA-B *5801 allele

126
Q

Allopurinol & Azathioprine

A

allopurinol can therefore lead to high levels of 6-mercaptopurine

a much reduced dose (e.g. 25%) must therefore be used if the combination cannot be avoided

127
Q

Allopurinol & Cyclophosphamide

A

allopurinol reduces renal clearance, therefore may cause marrow toxicity

128
Q

Allopurinol & Theophylline

A

allopurinol causes an increase in plasma concentration of theophylline by inhibiting its breakdown

129
Q

What is the Wolff-Chaikoff effect?

A

autoregulatory phenomenon where thyroxine formation is inhibited due to high levels of circulating iodide

130
Q

Amiodarone-induced thyrotoxicosis

Type 1 vs type 2

  1. Goiter ?
    MANAGEMENT?
A
  1. Goiter
    Type 1 present
    Type 2 absent
  2. Management

Type 1: Carbimazole or potassium perchlorate

Type 2: Corticosteroids

131
Q

Pathophysiology of Amiodarone-induced thyrotoxicosis Type 1

A

Excess iodine-induced thyroid hormone synthesis

132
Q

Pathophysiology of Amiodarone-induced thyrotoxicosis Type 2

A

Amiodarone-related destructive thyroiditis

133
Q

Cyclooxygenase is responsible for …………… synthesis.

A

prostaglandin, prostacyclin and thromboxane synthesis.

134
Q

The blocking ofthromboxane A2formation in platelets reduces ………….

A

the ability of platelets to aggregate

135
Q

Mechanism of action of Aspirin

A

Non reversible COX 1 and COX 2 inhibitor

136
Q

6 Drugs which may precipitate attack of Acute intermittent porphyria

A

barbiturates

halothane

benzodiazepines

alcohol

oral contraceptive pill

sulphonamides

137
Q

Tamoxifen is a…….

A

Selective oEstrogen Receptor Modulator (SERM)which acts as an oestrogen receptor antagonist and partial agonist.

138
Q

Tamoxifen is used for

A

management of oestrogen receptor positive breast cancer

139
Q

4 Side effects of Tamoxifen

A
  1. menstrual disturbance:
  2. Hot flushes
  3. VTE
  4. endometrial cancer
140
Q

Trastuzumab (Herceptin) is amonoclonal antibody directed against the ………

A

HER2/neu receptor

141
Q

Trastuzumab is used for…

A

It is used mainly in metastatic breast cancer although some patients with early disease are now also given trastuzumab.

142
Q

Side effects of Trastuzumab

A

flu-like symptoms and diarrhoea are common

cardiotoxicity
* more common when anthracyclines have also been used

an echo is usually performed before starting treatment

143
Q

Alpha-1

A
  1. salivary secretion
  2. hepatic glycogenolysis
  3. relaxation of GI smooth muscle
  4. vasoconstriction
  • SHRV
144
Q

Alpha-2 adrenoceptors

A

mainly presynaptic: inhibition of transmitter release (inc NA, Ach from autonomic nerves)

inhibits insulin

platelet aggregation

145
Q

Beta-1 adrenoceptors

A

mainly located in the heart

increase heart rate + force

146
Q

Beta-2

A

vasodilation

bronchodilation

relaxation of GI smooth muscle

147
Q

Beta-3 adrenoceptors

A

lipolysis

148
Q

phenylephrine is …

A

Alpha-1 agonists

149
Q

clonidine is

A

Alpha-2 agonists

150
Q

dobutamine is

A

Beta-1 agonists

151
Q

doxazosin is

A

alpha-1 blocker

152
Q

tamsulosin is

A

alpha-2 blocker

153
Q

phenoxybenzamine is

A

non-selective Alpha blocker

154
Q

Management of accidental injection e.g. resulting in digital ischaemia

A

local infiltration of phentolamine

155
Q

Types ( phases ) of Drug metabolism

A

phase I reactions: oxidation, reduction, hydrolysis

phase II reactions: conjugation.

156
Q

Antiarrhythmics: Vaughan Williams classification
Class 4

A

CCB
- Verapamil
- diltiazem

157
Q

Antiarrhythmics: Vaughan Williams classification
Class 3

A

Potassium Chanel blockers

  • amiodarone
  • Sotalol
  • Ibutilide
  • Bretylium
158
Q

Antiarrhythmics: Vaughan Williams classification
Class 2

A

BB
- Propranolol
- Atenolol
- Bisoprolol
- Metoprolol

159
Q

Antiarrhythmics: Vaughan Williams classification
Class 1a

A

Block sodium channels

Increases AP duration

  • Procainamide
  • Disopyramide
  • Quinidine

*PDQ

160
Q

Antiarrhythmics: Vaughan Williams classification
Class 1b

A

Block sodium channels
Decreases AP duration

  • Lidocaine
  • Mexiletine
  • Tocainide
161
Q

Antiarrhythmics: Vaughan Williams classification
Class 1c

A

Block sodium channels
No effect on AP duration

  • Propafenone
  • Encainide
  • Flecainide

*PEF

162
Q

Contraindications of Flecainide

A
  • post MI
  • structural heart disease: e.g. heart failure
  • sinus node dysfunction; second-degree or greater AV block
  • atrial flutter
163
Q

Adverse effects of Flecainide

A
  • negatively inotropic
  • bradycardia
  • proarrhythmic
  • oral paraesthesia
  • visual disturbances
164
Q

Indications of Flecainide

A
  • AFib
  • SVT associated with WPW
165
Q

Actions of adrenaline on α adrenergic receptors:

A

inhibits insulin secretion by the pancreas

stimulates glycogenolysis in the liver and muscle

stimulates glycolysis in muscle

166
Q

Actions of adrenaline onβ adrenergic receptors:

A

stimulates glucagon secretion in the pancreas

stimulates ACTH

stimulates lipolysis by adipose tissue

167
Q

adrenaline doses
- anaphylaxis
- cardiac arrest

A

anaphylaxis: 0.5ml 1:1,000 IM

cardiac arrest: 10ml 1:10,000 IV or 1ml of 1:1000 IV

168
Q

increased risk of……..with combined oral contraceptive pill

A

breast cancer
cervical cancer

very small risk of heart attacks and strokes

169
Q

Metformin should be titrated slowly, leave at …….. before increasing dose

A

least 1 week

170
Q

Avoidance of using hypotonic (0.45%) in paediatric patients - risk of ……

A

hyponatraemic encephalopathy

171
Q

Drugs affected by acetylator status

A

Hydralazine
Isoniazid

Sulfasalazine
Procainamide
Dapsone

*HI SPeeD

172
Q

Drugs exhibiting zero order kinetics

A

Heparin
Ethanol
Phenytoin
ASA

173
Q

P450 enzymes inductors (7)

A

Smoking
St John’s wort

Chronic alcohol intake
Carbamazepine

Phenytoin
Phenobarbitone

Rifampicin
GRiseofulvin

174
Q

Lithium toxicity maybe precipitated by

A

Dehydration
Renal failure
Drugs
- ACEi/ARBs
- thiazides
- NSAIDs
- metronidazole

175
Q

Levothyroxine acts via

A

Nuclear receptors

176
Q

To give NaHCO3 in TCA overdose if (4)

A

PH < 7.1
QRS > 160 ms
Arrhythmias
Hypotension

177
Q

Abciximab is

A

Glycoprotein IIb / IIIa receptor blocker

178
Q

Cocaine can cause abdominal pain due to …..

A

Ischemic colitis

179
Q

Pilocarpine is …….. agonist

A

muscarinic

180
Q

P450 enzyme inductors …1…. Warfarin

P450 enzyme inhibitors…2…. Warfarin

A
  1. Reduce the effect of warfarin
  2. Increase the effect of warfarin
181
Q

Heparin activates …1?…. Which inhibits……2?.

A
  1. Antithrombin III
  2. Thrombin III & IX, X, XI, XII
182
Q

MI 2ry to cocaine treated by

A

Iv benzodiazepines

183
Q

Which One of Anti TB medications need adjustment In renal impairment?

A

Ethambutol

184
Q

Cocaine in pregnancy can cause

A

Induce preterm labour

185
Q

Local anesthetic toxicity can be treated with

A

Iv 20 % lipid emulsion

186
Q

Ketamine is ……… receptor blocker

A

NMDA

187
Q

What is the most common feature of CO poisoning?

A

Headache

188
Q

What is The most common side effects of progesterone pills ?

A

Irregular vaginal bleeding

189
Q

Sidenafil is contraindicated by nitrates and …..

A

Nicordanil

190
Q

Enzymes are involved in phase I drug metabolism?

A
  1. Alcohol dehydrogenase
  2. Xanthine oxidase
191
Q

Drug monitoring
1. Ciclosporin

  1. Phenytoin
  2. Digoxin
  3. Lithium
A

1&2 immediately before the dose

  1. 6 hours post dose
  2. 12 hours post dose
192
Q

Cyanide …… the enzyme cytochrome C oxidase

A

Inhibits

193
Q

Which drug selectively blocks the epithelial Na transport channels ?

A

Amiloride

194
Q

Adrenaline vs Glucose, lactate, K

A

Adrenaline induced
hyperglycemia
Hyperlactatemia
Hypokalemia

MRCP Part 1 (17 decks)

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