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MRCP 2 > Pharmacy > Flashcards

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
Q

Prophylaxis for pathological fractures in those patients with bone metastases

A

Bisphosphonates and denosumab

Latter if eGFR <30

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26
Q

Management of INR 10, no bleeding. On it for AF

A

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)

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27
Q

Patient commenced on Abacavir what do you need to do

A

Can cause severe hypersensitivity so everyone is tested for HLA b5701 before starting

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28
Q

Methanol poisoning mx

A

fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol
haemodialysis
Folinic acid can reduce ophthal complications

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29
Q

Metformin dosing in Ramadan

A

During Ramadan, one-third of the normal metformin dose should be taken before sunrise and two-thirds should be taken after sunset

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30
Q

T2DM on Metformin, when do you add second drug?

A

Hba1c 58

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31
Q

New diagnosis of T2DM, eGFR <30, management

A

Can’t give Metformin

sulfonylurea (eg, glipizide, glimepiride)
or pioglitazone
or DDP 4

pioglitazone contra with bladder cancer

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32
Q

60y T2DM with new hypertension. Management.

A

ACE inhibitor first line regardless of their age

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33
Q

Alzheimer’s management

A 
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

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34
Q

Excessive salbutamol use in acute asthma can lead to

A

hyperlactatemia

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35
Q

Antiemetics in ACS?

A

Cyclizine should be avoided in patients with acute coronary events.

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36
Q

Which antidepressants increase risk of bleeding with warfarin?

A

SSRIs and SNRIs inhibit platelet function

St John’s wort is a p450 inducer

Can use mirtazapine

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37
Q

LMWH and thyroid

A

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

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38
Q

Parkinson’s psychosis

A

Ropinirole (dop agonist) is assx w psychosis and vis hallucinations, and impulsive behaviour. Reduce gradually!

Can be from PD itself though

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39
Q

Prevention of pathological fractures in bone mets

A

eGFR above 30 then bisphosphonates

Below 30 then denosumab (prevents osteoclasts by inhibition of RANKL)

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40
Q

Mx for disseminated Lyme’s

A

Ceftriaxone

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41
Q

Patient w her2 breast ca started on trastuzumab and anthracyclines… Risk?

A

Cardiotoxic so do echo before commencing

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42
Q

Management of myasthenic gravis

A

Long acting acetylcholinesterase inhibitors

Pyridostigmine

Can immunosuppress w prednisolone, azathioprine, cyclosporine

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43
Q

Jaundice after being treated for UTI

Why?

A

Nitro causes unconjugated bili (hepatocellular; ALT)

Trim causes obstructive (cholestatic, ALT and ALP)

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44
Q

When do you add Metformin in type1

A

Consider if BMI over 25

45
Q

Which anti diabetic med has anti-diuretic effect?

A

-gliflozin, SGLT-2 inhibitor

They reduce cardiovascular mortality

46
Q

Amiodarone thyroid

A

Type 1, increased uptake, goitre, Carbimazole or potassium perchlorate

Type 2, decreased, no goitre, corticosteroids

47
Q

Management for pt presenting with fever, confusion, with acute kidney injury, thrombocytopenia and haemolysis

A

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
Q

UTI in pregnancy

A

don’t give trimethoprim in first trime-ster

49
Q

Management of Chlamydia in pregnancy

A

Doxy is contraindicated all azithro, erythro, amoxi

50
Q

When do you consider glucagon-like peptide1 (GLP1) mimetic (e.g. exenatide)

A

If triple therapy not effective and
BMI >35 and medical/psychological issues from obesity
Or under but insulin would occupational hazard

51
Q

What meds should you avoid in cocaine-induced chest pain?

A

Beta-blockers

The rationale is that It may result in unopposed alpha-mediated coronary vasospasm…

52
Q

metoclopramide given,
Then over minutes developed severe neck stiffness, unable to open his eyelids
jaw was locked and tongue was protruding

A

Occulogyric crisis, give IM prpcyclidine

53
Q

Aspirin OD

A

salicylate levels > 450mg/L then IV sodium bicarbonate

54
Q

Acute complication to monitor for with ketamine

A

Raised ICP

NMDA receptor antagonist

55
Q

drug causes of oesinophilia

A

sulfasalazine

nitrofurantoin

56
Q

What abx is absolutely contraindicated with Methotrexate

A

Trimethoprim
- selective inhibitor of dihydrofolate reductase

Treat methotrexate toxicity with folinic acid

57
Q

Treatment for methotrexate toxicity

A

Folinic acid

58
Q

Radioiodine therapy contraindication

A

Pregnant
Breast feeding
Thyroid eye disease
CT contrast within 8wk

59
Q

Copd not responding to SABA

A

if no asthma features …add LABA + LAMA

If there are asthmatic features: add LABA + ICS

60
Q

H pylori eradication

A

Amoxicillin clari and omeprazole

Or metronidazole instead if pen allergic

61
Q

Poorly controlled T2DM, hard exudates, macular oedema and haemorrhages on fundoscopy, management?

A

Bevacizumab

Anti VEGF has been proven to reduce new vessel growth, retinal thickness and oedema and bleeding

Can use focal laser therapy

62
Q

management of patient overactive bladder symptoms, BG of Parkinson’s

A

Mirabegron (beta-3 agonist)

Oxybutynin can cause signif antimuscarinic SE like postural hypotension/urinary retention

63
Q

SE of isotretinoin therapy

A

anaemia, thrombocytopenia, thrombocytosis, increaseESR

can cause low mood but rare

64
Q

Which tb med shouldn’t be given in pt with cirrhosis

A

Pyrazinamide

Due to drug induced hepatitis

65
Q

What INR do you give Vit K

A

above 8 or above 5 if bleeding

66
Q

patient w >2 fragility fractures and T Score under -4

Management

A

Teriparatide (Subcut)

synth PTH analogue, promotes osteoblast activity

67
Q

mx of signif hypertriglyceridaemia

A

fibrates
e.g. ciprofibrate

statins do reduce triglyceride levels and they may be indicated, particularly if there is mixed hyperlipidaemia

68
Q

phenytoin toxicity

A

initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures

69
Q

hep induced thrombocytopenia mx

A

direct thrombin inhibitor e.g. argatroban

remember: low platelets but is actually a prothrombotic condition

70
Q

MOA Goserelin

A

synthetic GnRH analogs (agonist)

AKA LHRH

Given with Bicalutamide ( an androgen receptor antagonist - to reduce goserelin-induced tumour flare)

71
Q

MOA and Role of Bicalutamide

A

an androgen receptor antagonist

Given 3-7/7 before starting goserelin and continued for about 3/52

to reduce goserelin-induced tumour flare

72
Q

Febuxostat

A

It is used to prevent attacks of gout if Allopurinol SE intolerant or renal function worsened

73
Q

Develop rash after starting Allopurinol

BNF says it’s Common

A

Discontinue therapy

if rash mild re-introduce cautiously but discontinue immediately if recurrence

Can give Febuxostat instead

74
Q

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.

A

serotonin syndrome

tramadol and citalopram both exhibit serotonin reuptake inhibition

75
Q

patient presents w new onset confusion, Ammonia 197

What new antipsychotic drug was commenced?

A

valproate-associated hyperammonaemic encephalopathy

76
Q

post stroke mx if found to be in AF

A

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
Q

Drug management of MS

A

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
Q

memory aid for checking drug levels

A

“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
Q

SE of quinine or quinidine

A

called cinchonism (cinchona is the tree it’s from)

vomiting, vertigo, tinnitus, headache, blurred vision

(quinidine used for AF)

80
Q

Drug-induced pancreatitis

A 
Steroids (steroids)
And (Azathioprine)
Alcohol (alcohol)
are
Very (Valproate)
Damaging (Didanosine)
For (Furosemide)
The (Thiazide)
Pancreas (Pentamidine)
Man (mesalazine)
81
Q

SVT management

A

Vasovagal
Adenosine

If asthmatic: verapamil
DC cardioversion if adverse features

82
Q

Management of pulmonary artery hypertension

A

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
Q

SE colchicine

A

Diarrhoea

Can cause myoneuropathy

  • subacute proximal muscle weakness
  • tingling/numbness

Weakness resolves, neuropathy doesn’t

84
Q

drug mx for delirium in PD

A

Quetiapine

Remember: Haloperidol is a dopamine-antagonist and therefore will worsen the motor features of Parkinson’s disease

85
Q

what antihypertensive would you start if on lithium

A

amlodipine

ACEi, ARB, diuretics (esp thiazides) all increase lithium concentration so can cause toxicity

86
Q

drug causes of Sensorineural deafness

A

IV Vanc, Erythro,Gent, Furosemide

87
Q

5FU or capecitabine chemotherapy… what do you need to test for before?

A

test for Dihydropyrimidine dehydrogenase (DPD deficiency)

within a week can become septic and die due to build up of chemo

88
Q

pt w leukaemia on L-asparaginase chemo comes in w seizure. Why?

A

cerebral venous sinus thrombosis

89
Q

what do you test before Mercaptopurine or Azathioprine?

A

thiopurine methyltransferase (TPMT)

90
Q

what is the name of the toxicity in antifreeze?

A

Ethylene glycol toxicity

similar to alcohol…metabolic acidosis with high anion gap and high osmolar gap

91
Q

beta-blocker overdose management

A

atropine for brady

Glucagon…but hospitals often run out (!)
High insulin euglycaemic therapy (promotes glucose and lactate uptake in myocardium)

92
Q

Spice overdose

A

psychosis, seizures, stroke, MI, rhabdo…

93
Q

pt presents from house fire w 60% body surface area burn, hoarse voice. management

A

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
Q

management of status epilepticus

A

loraz IV / midaz IM Buccal

then IV Keppra 
or Phenytoin (SRFT IF NOT childbearing: Valproate)
95
Q

definition of convulsive status epilepticus

A

single seizure lasting >5 minutes, or

>= 2 seizures within a 5-minute period without the person returning to normal between them

96
Q

definition of refractory status epilepticus

A

Continues despite first and second line therapy

97
Q

vasopressor vs inotropes

A

vasopressor… vasoconstriction (noradrenaline)

Inotropes… cardiac contractility (dobutamine)

98
Q

What do you test before starting on Mesalazine

A

Renal function
FBC

Before starting, 3m , yearly

99
Q

SE warfarin

A

Haemorrhage
Teratogenic (can be used in breast feeding though)
Coumarin skin necrosis (due to PRotein C deficiency)
May increase risk of cholesterol embolus

100
Q

when to avoid pioglitazone ?

A

aka Thiazolidinediones, PPAR-gamma agonists

weight gain
Contra with bladder cancer
Causes fluid retention so avoid w HF

101
Q

Consider adding exenatide or Liraglutide (GLP-1 ) to metformin and a sulfonylurea if:

A

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
Q

peripheral neuroapthy from TB treatment

A

isoniazid, prevented with pyridoxine (Vitamin B6)

103
Q

p450 inducers

A

CRAP GPS induce rage

Carbamazepine 
Rifampicin  (Reduces INR)
bArbituates 
Phenytoin 
St Johns wort
Grisiofalvin
Phenobarbital
Sulphonylurea, st John's wort
104
Q

p450 inhibitors

A

Some Certain Silly Compounds Annoyingly Inhibit Enzymes, Grrrrrrr

Sodium valporate 
Ciprofloxacin 
Sulphonamide 
Cimetidine/omeprazole 
Antifungals, amiodarone 
Isoniazid (Increases INR)
Erythromycin/clarithromycin 
Grrrrapefruit juice
105
Q

management of Tropheryma whippelii

A

WHipple’s - oral co-trimoxazole for a year has lowest relapse rate

106
Q

cataplexy tx

A

oxybate

107
Q

nitro w reduced peak flow, shortness of breath and wheeze
Eosinophilia and normal kidney function
Ground glass changes

A

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
Q

risk of sodium nitroprusside

A

Cyanide accumulation occurs in overdose

MRCP 2 (13 decks)

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