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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
antiemetics according to cause
intracranial- cyclizine (add dex if raised ICP) anxiety- benzo drug induced- haloperidol metabolic- haloperidol pregnancy- promethazine postop- droperidol, dex, ondansetron
26
drugs for bowel obstruction during EoL
hyoscine butylbromide ocreotide second line
27
managing benzo OD
flumazenil (competitive GABA A action) if requiring ventilation c/i if pt has taken other meds that may cause seizures or head injury
28
beta blockers with membrane stabilising effects
propranolol and labetalol inhibit cardiac myocyte Na channels prolong QRS and impair cardiac conduction
29
beta blocker OD
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
30
CCB OD
hyperglycaemia
31
CTX- alkylating agent mechanism and adverse effects
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
32
alkylating agents adverse effects
classic e.g. cyclophosphamide > haemorrhagic cystitis pulm interstitial fibrosis non classic e.g. cisplatin > kidney failure, ototoxic, peripheral neuropathy
33
antimetabolite CTx mechanism and side effects
interfere with purine/pyramidine synthesis MTX> hepatic failure, pulm fibrosis 5FU- palmar plantar, cardiotox
34
antibiotics for CTx
intercalate into DNA > free radicals s/e: anthracycline (doxorubicin) CCF bleomycin pneumonitis, fibrosis mitomycin kidney failure, stomatitis, alopecia
35
vincristine mechanism and side effects
M phase specific prevents spindle formation > inhibits mitosis blistering, neuropathy, bronchospasm
36
paclitaxel mechanism and side effects
stabilises microtubules > inhibits mitosis sudden total alopecia myalgia, peripheral neuropathy
37
topoisomerase inhibitors side effects
cholinergic syndrome profuse diarrhoea
38
cyanide poisoning
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
cyanide vs CO
CO- improve rapidly after leaving environment cyanide- seizures may occur, fixed dilated pupils
40
digoxin mechanism and therapeutic window
inhibits Na/K ATPase increases intracellular Na, reduces K 0.5-0.9
41
digoxin toxicity
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
drugs that can cause urticaria and anaphylaxis
penicillin salicylates quinidine ACEi opiates cephalosporins hydralazine
43
drugs that can cause exanthematous rashes
penicillins, cephalosporins sulfonamides allopurinol NSAIDs
44
drugs that can cause fixed eruption
tetracyclines barbiturates dapsone chlordiazepoxide sulfonamides benzos NSAIDs quinine paracetamol
45
drugs that can cause DRESS
allopurinol carbamazepine lamotrigine NSAIDs phenytoin sulfonamides
46
drugs that can cause TEN/SJS
allopurinol sulfonamides penicillin carbamazepine phenytoin NSAIDs gold salicylates barbiturates
47
mechanism of drug rashes
immediate- IgE delayed (days to weeks)- IgG occurs quicker on repeated exposure
48
drug rashes blood tests
DRESS or hypersensitivity- liver dysfunction and eosinophilia AGEP- neutrophilia
49
causes of erythema nodosum
OCP, pregnancy penicillin, tetracyclines TB, strep sarcoid, IBD
50
ethylene glycol poisoning
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
causes of gynaecomastia
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
gynaecomastia management
danazol (inhibits gonadotrophins) tamoxifen testosterone
53
calcineurin inhibitors
e.g. ciclosporin, tacrolimus reduce IL2 production and T cell proliferation
54
antiproliferative immunosuppressants
e.g. MMF, azathioprine reduce cytokine induced T cell proliferation
55
mTOR inhibitors
e.g. sirolimus, everolimus inhibit antibody production bind to FKBP-12 > supress T cell proliferation
56
steroids immunosuppression
sequestration of CD4 T lymphocytes in reticuloendothelial system inhibit cytokines transcription
57
iron poisoning
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
treating lead poisoning
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
lithium therapeutic window and toxicity
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
P450 inducers
cigarettes, alcohol rifampicin carbamazepine st johns wort phenytoin, phenobarbitone > reduced therapeutic effect > increased metabolites > toxicity
61
liver enzyme inhibitors
chloramphenicol erythromycin sulfonamides ketoconazole isoniazid cimetidine ciproflox acute ethanol omeprazole disulfiram valproate
62
drugs causing prolonged QT
amiodarone, sotalol, procainamide erythromycin, trimethoprim terfenadine ketoconazole, fluconazole haloperidol, citalopram
63
causes of methaemaglobinaemia
cytochrome B5 reductase or pyruvate kinase def haemaglobinopathy M local anaesthetics aniline dyes benzene deriv chloroquine nitrites metoclopramide sulfonamide smoke
64
diagnosing methb
brown blood, doesn't oxidise normal pao2 reduced sao2 methb gold standard potassium cyanide distinguishes from sulfhaemaglobin
65
methb treatment
indicated if > 30% or symptomatic IV dextrose methylene blue IV ascorbic acid if MB c/i e.g. G6PD def exchange transfusion
66
methanol poisoning
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
managing NMS
lorazepam for agitation and catatonia dantrolene for hyperthermia and rigidity bromocriptine/amantadine
68
managing opiate toxicity
aim for RR > 12 and spo2 > 90%
69
managing organophosphate poisoning
atropine + pralidoxime chloride monitor tidal vol and strength of neck flexors there may be delayed effects 1-4 days after exposure
70
organophosphate ECG changes
AV block long QT brady peaked T ventric arrhythmias
71
indications for liver transplant in paracetamol OD
pH < 7.3 or encephalopathy III/IV and PT > 100 and Cr > 3.4
72
drugs causing parkinsonism
antipsychotics metoclopramide prochlorperazine tetrabenazine valproate lithium
73
drugs causing photosensitivity
thiazides tetracyclines NSAIDs quinine fluoroquinolones voriconazole chlorperazine furosemide sulfonamides amiodarone metformin
74
treating polymorphic light eruption
hydroxychloroquine oral steroids short course azathioprine
75
phototoxic vs photoallergic
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
drugs c/i in pregnancy
ACEi topiramate fluoxetine, lithium sulfonamides warfarin androgens
77
drugs that are safer to prescribe in breastfeeding
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
drugs c/i in breastfeeding
amiodarone chloramphenicol ergotamine iodides MTX lithium tetracyclines cabergoline pseudoephedrine
79
premature ejaculation drug treatment
dapoxetine SSRI
80
salicylate OD
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
serotonin syndrome features
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
treating serotonin syndrome
cyproheptadine propranolol may need ICU for hyperthermia, rhabdo, AKI, DIC
83
drug induced lupus
CNS and renal involvement rare ANA positive, dsDNA neg procainamide isoniazid hydralazine
84
cancers causing SIADH
SCLC pancreatic prostate lymphoma
85
SIADH osmolalities
urine > 100 serum < 275
86
SIADH treatment
demeclocycline blocks ADH tolvaptan vasopressin receptor antag
87
theophylline mechanism
adenosine antag phosphodiesterase inhib
88

MRCP 2 (12 decks)

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