physio + pharma

Question 1

causes raised ALP

Answer 1

liver: cholestasis, hepatitis // pages // osteomalacia // mets // hyperPTH // renal failure // pregnancy, growing, fracture

Question 2

causes raised ALP + Ca

Answer 2

bone mets // primary PTH // myeloma

Question 3

caused raised ALP + low Ca

Answer 3

osteomalacia, renal failure

Question 4

how does bilirubin form in body

Answer 4

breakdown product of heme –> biliverdin (+ iron) –> unconjugated bilirubin

Question 5

what does unconjugated bilirubin bind too

Answer 5

albumin

Question 6

how is bilirubin conjugated + excreted

Answer 6

by liver –> water soluble –> bile and broken down by bacteria –> feces + urine (10%)

Question 7

what causes raised levels of unconjuhated bilirubin

Answer 7

pre-hepatic eg haemolysis // hepatic eg liver disease, glucuronyl transferase deficiency

Question 8

what causes raised levels conjugated bilirubin

Answer 8

defective excretion eg Dubin-Johnson Syndrome, or cholestasis (gallstones, pancreas, drug induced, pregnancy)

Question 9

what level does bilirubin cause jaundice

Answer 9

> 35

Question 10

what medications cause a hepatcellular liver disease

Answer 10

(raised ALT>ALP) paracetamol // AEDs // TB // statins // amiodarone // methyldopa // nitrofurantoin // MAOi

Question 11

what medications cause a cholestatic liver disease

Answer 11

COCP // abx // steroids or testosterone // chlorpromazine, prochlorperazine // SURs

Question 12

causes liver cirrhosis

Answer 12

methotrexate // methyldopa // amiodarone

Question 13

mechanism PPIs

Answer 13

block HKATPase

Question 14

SE PPI

Answer 14

hypoNa, hypoMg // osteoporosis // C diff!

Question 15

opioid antidiarrhoeals

Answer 15

loperamide, diphenoxylate

Question 16

mechanism Metoclopramide

Answer 16

D2 receptor antagonist

Question 17

indications Metoclopramide

Answer 17

GORD // pro kinetic in gastroparesis (diabetic neuropathy) // pain in migraines

Question 18

SE Metoclopramide

Answer 18

EPSE eg oculogyric crisis // diarrhoea // hyperprolactin // tardive dyskinesia // Parkinsonism

Question 19

when to avoid Metoclopramide

Answer 19

bowel obstruction + Parkinson’s

Question 20

examples bulk forming laxatives

Answer 20

methylcellulose, fybrogel (ispalagal hulk)

Question 21

examples stimulant laxatives

Answer 21

Senna, biscadoyl

Question 22

example stool softener laxatives

Answer 22

docusate

Question 23

type of osmotic laxatives

Answer 23

laxido, poleyethlyene glycol (movicol), lactulose

Question 24

first line mx kids constipation

Answer 24

1 = polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) // 2 = stimulant (Senna)

Question 25

mechanism Cholestyramine

Answer 25

bole acid sequestratant –> decreased bile reabsorption –> decreased cholesterol reabsorption

Question 26

indications Cholestyramine

Answer 26

hyperlipidaemia // chrons diarrhoea after resection

Question 27

SE Cholestyramine

Answer 27

abdo cramps // decreased ADEK absorption // gallstones // rising triglycerides

Question 28

SE sulphalazine

Answer 28

rash, oligospermia, headache, Heinz body anaemia, lung fibrosis

Question 29

SE mesalazine + olsalazine

Answer 29

GI upset, pancreatitis!!!, interstitial nephritis, agranulocytosis

Question 30

monitoring 5ASAs

Answer 30

agranulocytosis –> FBC

Question 31

cautions in sulfalazine

Answer 31

G6PD def + allergy to aspirin