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Pharmacy Flashcards

1
Q

Tiotropium

A

LAMA

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2
Q

Adult with asthma not controlled by a SABA

A

add a low-dose ICS (beclomethasone)

Copd not responding to SABA…add LABA LAMA if no asthma or LABA ICS if asthma

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3
Q

patients on a SABA + ICS whose asthma is not well controlled

A

Add leukotriene receptor antagonist…

montelukast

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4
Q

Patient on aminophylline who’s current smoker

A

Current smokers -> liver enzyme induction -> higher doses aminophylline required

Statins, ciprofloxacin and an alcohol bingeetc do opposite

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5
Q

Alcohol affect on p450

A

chronic alcohol p450 inducer
acute alcohol p450 inhibitor

Think: acute alcohol makes you disinhibited

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6
Q

inadequately controlled asthma,

Serum eosinophilia and elevated fraction of exhaled nitric oxide (FENO)

A

Mepolizumab and other anti-IL-5 therapies can be used in adults with eosinophilic asthma

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7
Q

What improves prognosis in Afro-Caribbean patients with heart failure who are not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy

A

Hydrazine and nitrate (ISMN)

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8
Q

Management of hirtuism and acne in PCOS

A

COCP especially Co-cyprindiol contains both cyproterone, an anti-androgen, and ethinylestradiol, (a synthetic oestrogen)

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9
Q

Third line for HF after ACEi , beta, aldosterone

A

–ivabradine
IF LVF < 35% and sinus rhythm > 75

–sacubitril-valsartan
IF LVF < 35% and symptomatic
(needs ACEi or ARB wash-out period)

—digoxin if AF
( No benefit in mortality in HF, but may improve symptoms)

—hydralazine in combination with nitrate
IF Afro-Caribbean patients

—CRT
IF widened QRS (e.g. left bundle branch block)

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10
Q

Strengths of topical steroids

A

Help Every Budding Dermatologist

Hydrocortisone
Eumovate
Betnovate
Dermovate

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11
Q

Side effect of metoclopramide

A

Metoclopramide can cause drug-induced hyperprolactinaemia presenting as hypogonadism in men

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12
Q

Allopurinol SE intolerant or renal function worsened… Replacement.

A

Febuxostat

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13
Q

Pancytopenia after gout treatment… What interaction caused this?

A

Allopurinol interacts with azathioprine causing bone marrow suppression due to elevated 6-mercaptopurine

Absolute contraindication

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14
Q

Drugs that trigger psoriasis

A

Beta blockers
Antimalarial
Lithium
Ibuprofen ( NSAIDs )

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15
Q

Which juice affects warfarin most

A

Cranberry

Grapefruit is more simvastatin and ciclosporin

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16
Q

Treatment for patient with narcolepsy

A

Modafinil can be used for excessive sleepiness

weak dopamine reuptake inhibitor which indirectly activates the release of orexin and histamine

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17
Q

Drugs to avoid in WPW

A

drugs which can block AV node or enhance conduction down accessory pathway…

(ABCD)
Adenosine
Beta blockers
Calcium channel blockers
Digoxin.
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18
Q

Drug interaction cause of rhabdomyolysis

A

Rhabdomyolysis can result from co-prescription of clarithromycin and statins
As clari inhibits the CYP3A4 pathway

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19
Q

why shouldn’t you prescribe clarithromycin and statins together?

A

Clari inhibits the CYP3A4 pathway and can cause rhabdo

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20
Q

Patient with HIV on Eviplera (emtricitabine/rilpivirine/tenofovir) gets a viral blip because of new medication. Which one?

A

PPIs are absolutely contraindicated in patients on Eviplera (emtricitabine/rilpivirine/tenofovir)

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21
Q

Management of sulphonylurea OD

A

Dextrose

If no response then Octreotide (aka Sandostatin - synthetic somatostatin)

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22
Q

Hypertension not controlled on A+C

A

Add thiazide (indap)

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23
Q

Patient on salbutamol, sertraline, and sodium valproate presents due to new confusion, myoclonus and GCS 13

Diagnosis

A

hyperammonemic encephalopathy due to valproate

Check ammonia level, valproate level not relevant

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24
Q

Patient develops sore throat on carbimazole

A

Check neutrophils

If neutropaenia, stop carbimazole and start propylthiouracil until not neutropenic, then radioactive iodine

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25
Prophylaxis for pathological fractures in those patients with bone metastases
Bisphosphonates and denosumab | Latter if eGFR <30
26
Management of INR 10, no bleeding. On it for AF
INR > 8.0 (no bleeding) - stop warfarin, give oral vitamin K 1-5mg, repeat dose of vitamin K if INR high after 24 hours, restart when INR < 5.0 If major bleeding then also give prothrombin complex Give IV vit k if bleeding (1-3 for mild, 5 for major)
27
Patient commenced on Abacavir what do you need to do
Can cause severe hypersensitivity so everyone is tested for HLA b5701 before starting
28
Methanol poisoning mx
fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol haemodialysis Folinic acid can reduce ophthal complications
29
Metformin dosing in Ramadan
During Ramadan, one-third of the normal metformin dose should be taken before sunrise and two-thirds should be taken after sunset
30
T2DM on Metformin, when do you add second drug?
Hba1c 58
31
New diagnosis of T2DM, eGFR <30, management
Can't give Metformin sulfonylurea (eg, glipizide, glimepiride) or pioglitazone or DDP 4 pioglitazone contra with bladder cancer
32
60y T2DM with new hypertension. Management.
ACE inhibitor first line regardless of their age
33
Alzheimer's management
``` MMSE 10-26/30: Acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) relatively CONTRA in bradyc and 1st deg HB ``` MMSE under 10 or above contra memantine (an NMDA receptor antagonist) Same in Lewybody
34
Excessive salbutamol use in acute asthma can lead to
hyperlactatemia
35
Antiemetics in ACS?
Cyclizine should be avoided in patients with acute coronary events.
36
Which antidepressants increase risk of bleeding with warfarin?
SSRIs and SNRIs inhibit platelet function St John's wort is a p450 inducer Can use mirtazapine
37
LMWH and thyroid
Can transiently rise serum thyroid levels It increases lipoprotein lipase so increased free fatty acids... High FFA inhibit funding of thyroid hormones, so increased quantity when measured
38
Parkinson's psychosis
Ropinirole (dop agonist) is assx w psychosis and vis hallucinations, and impulsive behaviour. Reduce gradually! Can be from PD itself though
39
Prevention of pathological fractures in bone mets
eGFR above 30 then bisphosphonates Below 30 then denosumab (prevents osteoclasts by inhibition of RANKL)
40
Mx for disseminated Lyme's
Ceftriaxone
41
Patient w her2 breast ca started on trastuzumab and anthracyclines... Risk?
Cardiotoxic so do echo before commencing
42
Management of myasthenic gravis
Long acting acetylcholinesterase inhibitors Pyridostigmine Can immunosuppress w prednisolone, azathioprine, cyclosporine
43
Jaundice after being treated for UTI | Why?
Nitro causes unconjugated bili (hepatocellular; ALT) | Trim causes obstructive (cholestatic, ALT and ALP)
44
When do you add Metformin in type1
Consider if BMI over 25
45
Which anti diabetic med has anti-diuretic effect?
-gliflozin, SGLT-2 inhibitor They reduce cardiovascular mortality
46
Amiodarone thyroid
Type 1, increased uptake, goitre, Carbimazole or potassium perchlorate Type 2, decreased, no goitre, corticosteroids
47
Management for pt presenting with fever, confusion, with acute kidney injury, thrombocytopenia and haemolysis
TTP plasma exchange daily and high-dose methylprednisolone for 3 days until platelet counts return to normal HUS has more severe AKI and no neuro signs
48
UTI in pregnancy
don't give trimethoprim in first trime-ster
49
Management of Chlamydia in pregnancy
Doxy is contraindicated all azithro, erythro, amoxi
50
When do you consider glucagon-like peptide1 (GLP1) mimetic (e.g. exenatide)
If triple therapy not effective and BMI >35 and medical/psychological issues from obesity Or under but insulin would occupational hazard
51
What meds should you avoid in cocaine-induced chest pain?
Beta-blockers The rationale is that It may result in unopposed alpha-mediated coronary vasospasm...
52
metoclopramide given, Then over minutes developed severe neck stiffness, unable to open his eyelids jaw was locked and tongue was protruding
Occulogyric crisis, give IM prpcyclidine
53
Aspirin OD
salicylate levels > 450mg/L then IV sodium bicarbonate
54
Acute complication to monitor for with ketamine
Raised ICP NMDA receptor antagonist
55
drug causes of oesinophilia
sulfasalazine | nitrofurantoin
56
What abx is absolutely contraindicated with Methotrexate
Trimethoprim - selective inhibitor of dihydrofolate reductase Treat methotrexate toxicity with folinic acid
57
Treatment for methotrexate toxicity
Folinic acid
58
Radioiodine therapy contraindication
Pregnant Breast feeding Thyroid eye disease CT contrast within 8wk
59
Copd not responding to SABA
if no asthma features ...add LABA + LAMA If there are asthmatic features: add LABA + ICS
60
H pylori eradication
Amoxicillin clari and omeprazole Or metronidazole instead if pen allergic
61
Poorly controlled T2DM, hard exudates, macular oedema and haemorrhages on fundoscopy, management?
Bevacizumab Anti VEGF has been proven to reduce new vessel growth, retinal thickness and oedema and bleeding Can use focal laser therapy
62
management of patient overactive bladder symptoms, BG of Parkinson's
Mirabegron (beta-3 agonist) Oxybutynin can cause signif antimuscarinic SE like postural hypotension/urinary retention
63
SE of isotretinoin therapy
anaemia, thrombocytopenia, thrombocytosis, increaseESR can cause low mood but rare
64
Which tb med shouldn't be given in pt with cirrhosis
Pyrazinamide Due to drug induced hepatitis
65
What INR do you give Vit K
above 8 or above 5 if bleeding
66
patient w >2 fragility fractures and T Score under -4 | Management
Teriparatide (Subcut) | synth PTH analogue, promotes osteoblast activity
67
mx of signif hypertriglyceridaemia
fibrates e.g. ciprofibrate statins do reduce triglyceride levels and they may be indicated, particularly if there is mixed hyperlipidaemia
68
phenytoin toxicity
initially: dizziness, diplopia, nystagmus, slurred speech, ataxia later: confusion, seizures
69
hep induced thrombocytopenia mx
direct thrombin inhibitor e.g. argatroban remember: low platelets but is actually a prothrombotic condition
70
MOA Goserelin
synthetic GnRH analogs (agonist) AKA LHRH Given with Bicalutamide ( an androgen receptor antagonist - to reduce goserelin-induced tumour flare)
71
MOA and Role of Bicalutamide
an androgen receptor antagonist Given 3-7/7 before starting goserelin and continued for about 3/52 to reduce goserelin-induced tumour flare
72
Febuxostat
It is used to prevent attacks of gout if Allopurinol SE intolerant or renal function worsened
73
Develop rash after starting Allopurinol BNF says it's Common
Discontinue therapy if rash mild re-introduce cautiously but discontinue immediately if recurrence Can give Febuxostat instead
74
patient on tramadol and citalopram, increasing agitation, vomiting and diarrhoea 38.3°C, her pulse was 120 beats per minute and her BP was 90/50 mmHg. She was flushed and shivering.
serotonin syndrome tramadol and citalopram both exhibit serotonin reuptake inhibition
75
patient presents w new onset confusion, Ammonia 197 | What new antipsychotic drug was commenced?
valproate-associated hyperammonaemic encephalopathy
76
post stroke mx if found to be in AF
Aspirin 300mg for 2 weeks is the first line treatment of acute ischaemic stroke/TIA (NICE CG68). After two weeks- long term antiplatelet for secondary prevention is Clopidogrel (or warfarin if patient found to have AF).
77
Drug management of MS
5d of Oral methylpred (non-inferior to IV) - shortens duration but no effect on degree of recovery 2 or more in 2yr then consider DMARDs - Beta-interferon - glatiramer acetate (immunomod) - natalizumab (inhibiting leucocytes moving across the endothelium of BBB) - fingolimod (prevents lymphocytes from leaving lymph nodes)
78
memory aid for checking drug levels
"Please don't check, Call just before, I have a Date at 6 so I'll be Late at 12" Phenytoin .. No need to monitor Cyclosporin .. Trough just b4 the dose Digoxin .. 6 hrs after Lithium .. 12 hrs after Peak and trough for gent
79
SE of quinine or quinidine
called cinchonism (cinchona is the tree it's from) vomiting, vertigo, tinnitus, headache, blurred vision (quinidine used for AF)
80
Drug-induced pancreatitis
``` Steroids (steroids) And (Azathioprine) Alcohol (alcohol) are Very (Valproate) Damaging (Didanosine) For (Furosemide) The (Thiazide) Pancreas (Pentamidine) Man (mesalazine) ```
81
SVT management
Vasovagal Adenosine If asthmatic: verapamil DC cardioversion if adverse features
82
Management of pulmonary artery hypertension
acute vasodilator testing by right heart catheterisation --- positive then PO calcium channel bl --- negative (majority) Prostacyclin analogues: treprostinil, iloprost Endothelin receptor antagonists: bosentan, ambrisentan Sildenafi (can be given with iloprost
83
SE colchicine
Diarrhoea Can cause myoneuropathy - subacute proximal muscle weakness - tingling/numbness Weakness resolves, neuropathy doesn't
84
drug mx for delirium in PD
Quetiapine | Remember: Haloperidol is a dopamine-antagonist and therefore will worsen the motor features of Parkinson's disease
85
what antihypertensive would you start if on lithium
amlodipine ACEi, ARB, diuretics (esp thiazides) all increase lithium concentration so can cause toxicity
86
drug causes of Sensorineural deafness
IV Vanc, Erythro,Gent, Furosemide
87
5FU or capecitabine chemotherapy... what do you need to test for before?
test for Dihydropyrimidine dehydrogenase (DPD deficiency) within a week can become septic and die due to build up of chemo
88
pt w leukaemia on L-asparaginase chemo comes in w seizure. Why?
cerebral venous sinus thrombosis
89
what do you test before Mercaptopurine or Azathioprine?
thiopurine methyltransferase (TPMT)
90
what is the name of the toxicity in antifreeze?
Ethylene glycol toxicity similar to alcohol...metabolic acidosis with high anion gap and high osmolar gap
91
beta-blocker overdose management
atropine for brady Glucagon...but hospitals often run out (!) High insulin euglycaemic therapy (promotes glucose and lactate uptake in myocardium)
92
Spice overdose
psychosis, seizures, stroke, MI, rhabdo...
93
pt presents from house fire w 60% body surface area burn, hoarse voice. management
14L fluid in first 24h ! (Parkland formula to work out fluids) Secure airway Manage CO poisoning w 100% O2 (reduces half life) Consider hyperbaric if coma for CO poisoning, end-organ hypoxia, >25% sat or >15% if preg Check for cyanide poisoning (from melted plastic) Give hydroxocobalamin IV
94
management of status epilepticus
loraz IV / midaz IM Buccal ``` then IV Keppra or Phenytoin (SRFT IF NOT childbearing: Valproate) ```
95
definition of convulsive status epilepticus
single seizure lasting >5 minutes, or | >= 2 seizures within a 5-minute period without the person returning to normal between them
96
definition of refractory status epilepticus
Continues despite first and second line therapy
97
vasopressor vs inotropes
vasopressor... vasoconstriction (noradrenaline) Inotropes... cardiac contractility (dobutamine)
98
What do you test before starting on Mesalazine
Renal function FBC Before starting, 3m , yearly
99
SE warfarin
Haemorrhage Teratogenic (can be used in breast feeding though) Coumarin skin necrosis (due to PRotein C deficiency) May increase risk of cholesterol embolus
100
when to avoid pioglitazone ?
aka Thiazolidinediones, PPAR-gamma agonists weight gain Contra with bladder cancer Causes fluid retention so avoid w HF
101
Consider adding exenatide or Liraglutide (GLP-1 ) to metformin and a sulfonylurea if:
BMI >= 35 kg/m² if issues due to high weight OR BMI < 35 kg/m² and weight loss would benefit other comorbidities, or insulin is unacceptable
102
peripheral neuroapthy from TB treatment
isoniazid, prevented with pyridoxine (Vitamin B6)
103
p450 inducers
CRAP GPS induce rage ``` Carbamazepine Rifampicin (Reduces INR) bArbituates Phenytoin St Johns wort Grisiofalvin Phenobarbital Sulphonylurea, st John's wort ```
104
p450 inhibitors
Some Certain Silly Compounds Annoyingly Inhibit Enzymes, Grrrrrrr ``` Sodium valporate Ciprofloxacin Sulphonamide Cimetidine/omeprazole Antifungals, amiodarone Isoniazid (Increases INR) Erythromycin/clarithromycin Grrrrapefruit juice ```
105
management of Tropheryma whippelii
WHipple's - oral co-trimoxazole for a year has lowest relapse rate
106
cataplexy tx
oxybate
107
nitro w reduced peak flow, shortness of breath and wheeze Eosinophilia and normal kidney function Ground glass changes
pulmonary eosinophilia Nitrofurantoin can also cause lung fibrosis but that is restrictive, i.e. no reduced peak flow Eosinophilic polyangiitis with granulomatosis would have deranged KFT
108
risk of sodium nitroprusside
Cyanide accumulation occurs in overdose

MRCP 2 (13 decks)

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