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MRCP 2 > pharmacology/toxicology > Flashcards

pharmacology/toxicology Flashcards

1
Q

diagnosing hereditary angioedema

A

C4
> if low, C1-INH
skin biopsy to confirm

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2
Q

angioedema presentation depends on..

A

whether bradykinin or histamine/mast cell mediated

histamine mediated causes more urticaria and superficial swelling

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3
Q

angioedema treatment according to type

A

antihistamines- good response from allergic but not HAE or ACei induced

glucocorticoids- good response from allergic but not so much HAE or ACEi induced

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4
Q

hereditary angioedema treatment

A

C1-INH concentrates acute and prophylaxis
bradykinin inhibitors, icatibant
attenuated androgens
TXA to spare C1-INH
immunotherapy w/ biologics

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5
Q

penicillins adverse effects

A

interstitial nephritis
encephalopathy
cholestatic jaundice (coamox)
c diff colitis

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6
Q

cephalosporin adverse effects

A

anaphylaxis
c diff colitis

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7
Q

carbapenem adverse effects

A

seizures (imipenem)

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8
Q

macrolide mechanism

A

e.g. erythromycin, clarithromycin, azithromycin
inhibits 50S ribosomal subunit

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9
Q

macrolides adverse effects

A

P450 inhib (stop statin)
QTc prolongation
thrombophlebitis
cholestatic jaundice

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10
Q

tetracycline mechanism

A

30S ribosome subunit inhibition

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11
Q

tetracycline adverse effects

A

photosensitivity
renal impairment
tooth staining (avoid in pregnancy and children < 8y)

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12
Q

glycopeptide mechanism

A

e.g. vanc, teic
inhibits peptidoglycan synthesis

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13
Q

glycopeptide adverse effects

A

(teic, vanc)
ototoxic
nephrotoxic
red man syndrome

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14
Q

aminoglycosides are c/i in..

A

myaesthenia gravis

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15
Q

oxazolidiones mechanism

A

e.g. linezolid, cycloserine
50S inhibition

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16
Q

oxazolidione adverse effects

A

(linezolid, cycloserine)
agranulocytosis
pancreatitis

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17
Q

sulfonamide mechanism

A

inhibits folate and DNA synthesis

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18
Q

sulfonamide adverse effects

A

teratogenic
agranulocytosis
SJS

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19
Q

quinolone mechanism

A

e.g. ciproflox, levoflox
DNA gyrase inhib

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20
Q

quinolone adverse effects

A

(ciproflox, levoflox)
tendonitis, achilles rupture

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21
Q

diagnosing LMWH or DOC OD

A

elevated anti Xa levels
prolonged APTT

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22
Q

TCA OD management

A

activated charcoal/lavage if within 1h
sodium bicarb if ECG changes/hypotension
or vasopressors or IV glucagon
benzos for seizures

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23
Q

venlafaxine OD management

A

charcoal/lavage if within 1h
benzos for seizures
sodium bicarb for ECG changes

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24
Q

avoid co-prescribing TCA with…

A

SNRI, SSRI
antifungals
buproprion
cimetidine
diltiazem, verapamil
HIV protease inhibitors

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25
Q

antiemetics according to cause

A

intracranial- cyclizine (add dex if raised ICP)
anxiety- benzo
drug induced- haloperidol
metabolic- haloperidol
pregnancy- promethazine
postop- droperidol, dex, ondansetron

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26
Q

drugs for bowel obstruction during EoL

A

hyoscine butylbromide
ocreotide second line

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27
Q

managing benzo OD

A

flumazenil (competitive GABA A action) if requiring ventilation
c/i if pt has taken other meds that may cause seizures or head injury

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28
Q

beta blockers with membrane stabilising effects

A

propranolol and labetalol
inhibit cardiac myocyte Na channels
prolong QRS and impair cardiac conduction

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29
Q

beta blocker OD

A

prolonged QT, QRS
> VT
CNS depression, hypoglycaemia, resp depression and bronchospasm

atenolol and bisoprolol are less likely to cross BBB and cause neuro symptoms (hydrophilic)

tx:
IV glucagon for hypotension, shock
IV bicarb for wide QRS or hypotension not improving
atropine
insulin w/ dextrose
in the case of arrest, CPR should be continued for 1h

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30
Q

CCB OD

A

hyperglycaemia

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31
Q

CTX- alkylating agent mechanism and adverse effects

A

classic e.g. cyclophosphamide
form bonds with proteins
> inactivate enzymes involved in DNA production and protein synthesis

non classic e.g. cisplatin
cross link DNA strands
> interrupt normal DNA

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32
Q

alkylating agents adverse effects

A

classic e.g. cyclophosphamide
> haemorrhagic cystitis
pulm interstitial fibrosis

non classic e.g. cisplatin
> kidney failure, ototoxic, peripheral neuropathy

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33
Q

antimetabolite CTx mechanism and side effects

A

interfere with purine/pyramidine synthesis

MTX> hepatic failure, pulm fibrosis
5FU- palmar plantar, cardiotox

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34
Q

antibiotics for CTx

A

intercalate into DNA > free radicals

s/e:
anthracycline (doxorubicin) CCF
bleomycin pneumonitis, fibrosis
mitomycin kidney failure, stomatitis, alopecia

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35
Q

vincristine mechanism and side effects

A

M phase specific
prevents spindle formation
> inhibits mitosis

blistering, neuropathy, bronchospasm

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36
Q

paclitaxel mechanism and side effects

A

stabilises microtubules
> inhibits mitosis

sudden total alopecia
myalgia, peripheral neuropathy

37
Q

topoisomerase inhibitors side effects

A

cholinergic syndrome
profuse diarrhoea

38
Q

cyanide poisoning

A

sources: cig smoking, plastic combustion, paint and nylon, printing, dying

inhibits oxidative phosphorylation during aerobic metabolism
> hypoxia, lactic acidosis
switch from aerobic to anaerobic metabolism

chronic> predominantly neuro/neuropsychiatric e.g. parkinsonism

tx:
IV sodium thiosulfate if mild
IV hydroxycobalamin if mod
both if severe

39
Q

cyanide vs CO

A

CO- improve rapidly after leaving environment
cyanide- seizures may occur, fixed dilated pupils

40
Q

digoxin mechanism and therapeutic window

A

inhibits Na/K ATPase
increases intracellular Na, reduces K
0.5-0.9

41
Q

digoxin toxicity

A

risk is increased by reduced renal clearance, hypoK, hypoMg, hyperCa, verapamil, diltiazem, amiodarone, ketoconazole, erythromycin

correct electrolyte abnormalities
more hyperkalaemia correlates with mortality
BUT calcium gluconate can cause stone heart
Fab for life threatening/unstable arrhythmia or hyperkalaemia or end organ dysfunction

42
Q

drugs that can cause urticaria and anaphylaxis

A

penicillin
salicylates
quinidine
ACEi
opiates
cephalosporins
hydralazine

43
Q

drugs that can cause exanthematous rashes

A

penicillins, cephalosporins
sulfonamides
allopurinol
NSAIDs

44
Q

drugs that can cause fixed eruption

A

tetracyclines
barbiturates
dapsone
chlordiazepoxide
sulfonamides
benzos
NSAIDs
quinine
paracetamol

45
Q

drugs that can cause DRESS

A

allopurinol
carbamazepine
lamotrigine
NSAIDs
phenytoin
sulfonamides

46
Q

drugs that can cause TEN/SJS

A

allopurinol
sulfonamides
penicillin
carbamazepine
phenytoin
NSAIDs
gold
salicylates
barbiturates

47
Q

mechanism of drug rashes

A

immediate- IgE
delayed (days to weeks)- IgG
occurs quicker on repeated exposure

48
Q

drug rashes blood tests

A

DRESS or hypersensitivity- liver dysfunction and eosinophilia
AGEP- neutrophilia

49
Q

causes of erythema nodosum

A

OCP, pregnancy
penicillin, tetracyclines
TB, strep
sarcoid, IBD

50
Q

ethylene glycol poisoning

A

metabolite oxalic acid is nephrotoxic- calcium oxalate crystals deposit in tubules and cause necrosis
may also > hypoCa, hypoMg, hyperK
metab acidosis, raised anion and osmolar gap

antedote fomepizole or ethanol
only give calcium gluconate for hypocalcaemia if prolonged QT or persistent convulsions
haemodialysis if severe acidosis or electrolyte imbalance or renal failure

51
Q

causes of gynaecomastia

A

chronic renal/liver disease
HCG or oestrogen producing tumours
tumours compressing pituitary stalk
male breast ca
gonadal dailure
hyperPTH, hypothyroid

digoxin, opiates
spiro, cimetidine, cyproterone, antipsychotics
metro, domperidone, antiretrovirals, PPIs
heroin, anabolic steroids, aromatherapy

52
Q

gynaecomastia management

A

danazol (inhibits gonadotrophins)
tamoxifen
testosterone

53
Q

calcineurin inhibitors

A

e.g. ciclosporin, tacrolimus
reduce IL2 production and T cell proliferation

54
Q

antiproliferative immunosuppressants

A

e.g. MMF, azathioprine
reduce cytokine induced T cell proliferation

55
Q

mTOR inhibitors

A

e.g. sirolimus, everolimus
inhibit antibody production
bind to FKBP-12
> supress T cell proliferation

56
Q

steroids immunosuppression

A

sequestration of CD4 T lymphocytes in reticuloendothelial system
inhibit cytokines transcription

57
Q

iron poisoning

A

impaired oxidative phosphorylation
> mitochondrial dysfunction
> anaerobic resp and cell death

> liver toxicity and myocardial siderosis, metabolic lactic acidosis, gastric outlet obstruction

tx:
observe if < 500 micrograms/dl and mild symptoms
IV desferoxamine

58
Q

treating lead poisoning

A

dimercaprol, succimer or sodium calcium edetate chelation (CVS and neuro tox often not reversed by chelation)
ICU if encephalopathic
long term follow up due to storage in bones

59
Q

lithium therapeutic window and toxicity

A

0.4-1
test 12h post dose

hyponatraemia, diuretics and dehydration can reduce renal clearance of lithium because it is processed similarly to Na in kidneys

tx: stop diuretics, increase fluids, dialysis

60
Q

P450 inducers

A

cigarettes, alcohol
rifampicin
carbamazepine
st johns wort
phenytoin, phenobarbitone

> reduced therapeutic effect
increased metabolites > toxicity

61
Q

liver enzyme inhibitors

A

chloramphenicol
erythromycin
sulfonamides
ketoconazole
isoniazid
cimetidine
ciproflox
acute ethanol
omeprazole
disulfiram
valproate

62
Q

drugs causing prolonged QT

A

amiodarone, sotalol, procainamide
erythromycin, trimethoprim
terfenadine
ketoconazole, fluconazole
haloperidol, citalopram

63
Q

causes of methaemaglobinaemia

A

cytochrome B5 reductase or pyruvate kinase def
haemaglobinopathy M
local anaesthetics
aniline dyes
benzene deriv
chloroquine
nitrites
metoclopramide
sulfonamide
smoke

64
Q

diagnosing methb

A

brown blood, doesn’t oxidise
normal pao2 reduced sao2
methb gold standard
potassium cyanide distinguishes from sulfhaemaglobin

65
Q

methb treatment

A

indicated if > 30% or symptomatic
IV dextrose
methylene blue IV
ascorbic acid if MB c/i e.g. G6PD def
exchange transfusion

66
Q

methanol poisoning

A

metabolised to formaldehyde then formic acid
may have normal pH at presentation

tx: fomepizole, ethanol, sodium bicarb, dialysis
dialysis indications:
> 500 mg/l
visual/CNS
severe metab acidosis or electrolyte imbalance
renal failure
refractory deterioration

67
Q

managing NMS

A

lorazepam for agitation and catatonia
dantrolene for hyperthermia and rigidity
bromocriptine/amantadine

68
Q

managing opiate toxicity

A

aim for RR > 12 and spo2 > 90%

69
Q

managing organophosphate poisoning

A

atropine + pralidoxime chloride
monitor tidal vol and strength of neck flexors
there may be delayed effects 1-4 days after exposure

70
Q

organophosphate ECG changes

A

AV block
long QT
brady
peaked T
ventric arrhythmias

71
Q

indications for liver transplant in paracetamol OD

A

pH < 7.3
or
encephalopathy III/IV
and PT > 100
and Cr > 3.4

72
Q

drugs causing parkinsonism

A

antipsychotics
metoclopramide
prochlorperazine
tetrabenazine
valproate
lithium

73
Q

drugs causing photosensitivity

A

thiazides
tetracyclines
NSAIDs
quinine
fluoroquinolones
voriconazole
chlorperazine
furosemide
sulfonamides
amiodarone
metformin

74
Q

treating polymorphic light eruption

A

hydroxychloroquine
oral steroids short course
azathioprine

75
Q

phototoxic vs photoallergic

A

toxic:
mins-hours
sun exposed skin only affected
pigment changes
epidermal degeneration, dermal oedema

allergics:
24h or more
can spread to other parts of skin
no pigment changes
epidermal spongiosis

76
Q

drugs c/i in pregnancy

A

ACEi
topiramate
fluoxetine, lithium
sulfonamides
warfarin
androgens

77
Q

drugs that are safer to prescribe in breastfeeding

A

highly protein bound
low plasma: milk ratio
shorter half life
drugs safe in pregnancy
topical/inhaled
poor bioavailability

heparin, insulin, gent, cephalosporins, omeprazole, lansoprazole
ibuprofen
warfarin
Levonelle emergency contraception

78
Q

drugs c/i in breastfeeding

A

amiodarone
chloramphenicol
ergotamine
iodides
MTX
lithium
tetracyclines
cabergoline
pseudoephedrine

79
Q

premature ejaculation drug treatment

A

dapoxetine SSRI

80
Q

salicylate OD

A

in aspirin and wintergreen oil
metab acidosis + resp alkalosis (RA usually occurs before MA)
take levels 4 hours after asymptomatic OD, 2 hours after symptomatic

tx:
IV fluids and dextrose
IV bicarb
treat hyperkalaemia aggressively
dialyse if coma or > 900 or > 700 with acidosis

81
Q

serotonin syndrome features

A

spontaneous clonus
inducible clonus + agitation or sweating
ocular clonus + agitation or sweating
hypertonia + temp > 38 + ocular or inducible clonus

often misdiagnosed as NMS
but presents over hours rather than days/weeks

82
Q

treating serotonin syndrome

A

cyproheptadine
propranolol
may need ICU for hyperthermia, rhabdo, AKI, DIC

83
Q

drug induced lupus

A

CNS and renal involvement rare
ANA positive, dsDNA neg

procainamide
isoniazid
hydralazine

84
Q

cancers causing SIADH

A

SCLC
pancreatic
prostate
lymphoma

85
Q

SIADH osmolalities

A

urine > 100
serum < 275

86
Q

SIADH treatment

A

demeclocycline blocks ADH
tolvaptan vasopressin receptor antag

87
Q

theophylline mechanism

A

adenosine antag
phosphodiesterase inhib

88
Q
A

MRCP 2 (12 decks)

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