Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 3 > Prescribing And Pharmacology > Flashcards

Prescribing And Pharmacology Flashcards

1
Q

What is the usual loading dose of digoxin for atrial fibrillation?

A

For rapid digitalisation: 0.75-1.5mg PO over 24h in divided doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the usual maintenance dose of digoxin for atrial fibrillation?

A

According to renal function and initial loading dose

Usual range 125-250 micrograms once daily PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the dose of digoxin for heart failure for patients in sinus rhythm?

A

65-125 micrograms PO once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What investigations should be done for a patient with suspected digitalis toxicity? And what are you looking for with each?

A

Serum digoxin level: therapeutic level 0.6-2.6ng/mL
U and Es: acute - hyperkalaemia, chronic - hypokalaemia, hypomagnesaemia
ECG: dysrhythmia, sinus bradycardia, AV conduction block, ventricular ectopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the management for acute digitalis toxicity?

A 
Hydration with IV fluids
Oxygenation and support of ventilatory function
Discontinuation of drug
Correction of electrolyte imbalances
Activated charcoal
Binding resin: cholestyramine 
Digoxin immune Fab (fragment antigen binding)
Management of dysthymias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What blood tests need regular monitoring in patients prescribed IV vancomycin?

A

Renal function

Vancomycin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which class of medication is first line for panic disorder? Give examples

A 
SSRI 
Fluoxetine 
Paroxetine
Sertraline
Citalopram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are typical side effects of statins?

A 
Myalgia 
Headaches
Nausea
Hepatitis 
Myositis/rhabdomyolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the appropriate treatment for c diff?

A

Oral metronidazole or oral vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drug is used to manage hyperthyroidism?

A

Carbimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

By what mechanisms is metoclopramide an anti emetic?

A

Increased GI motility
Increases sphincter tone
Centrally: dopaminergic antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A 44 year old man is diagnosed with TB. He has a history of mitral stenosis and AF. He is commenced on therapy. 3 weeks later his INR increased to 5.6. Which medication is likely to have caused this and why?

A

Isoniazid inhibits P450 system of liver enzymes so therefore inhibit warfarin metabolism and will therefore increase INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the difference between unfractionated and low molecular weight heparin?

A

Unfractionated forms a complex which activates antithrombin III to inhibits thrombin, Xa, IXa, XIa and XIIa. IV, short duration of action. Monitor with APTT. Useful where high risk of bleeding as can be terminated rapidly
LMWH only increases action of antithrombin III on Xa. Subcutaneous, long duration of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is heparin induced thrombocytopenia?

A

Antibodies form against complexes of platelet factor 4 and heparin
Induce platelet activation by cross linking
Features include greater than 50% reduction in platelets, thrombosis and skin allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you reverse heparin overdose?

A

Protamine sulphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the mechanism of action of clopidogrel?

A

Antagonist of P2Y12 ADP receptor inhibiting activation of platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is bioavailability? What impact does this have on IV drugs?

A

Proportion of administered drug that reaches the systemic circulation
Therefore always 100% for IV drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why do angina sufferers use a sub lingual spray rather than swallow a tablet?

A

Absorption is rapid and bioavailability is high as it goes straight into the circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which is the most important of the cytochrome P450 enzymes?

A

CYP2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is phase 1 metabolism?

A

Modification
Introduces reactive groups
Oxidation, reduction, hydrolysis
Enzyme catalysed by p450 system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is phase 2 metabolism?

A

Conjugation
Mostly in the liver
Addition of glucuronide, sulphate and other charged groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give examples of p450 inducers

A 
Barbiturates
Carbamazepine
Alcohol 
Griseofulvin 
Phenytoin
Primidone
Rifampicin 
CRAPGPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give examples of p450 inhibitors

A 
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid 
Ciprofloxacin
Ethanol (acute)
Sulphonamides 
ODEVICES
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which fruit is an enzyme inhibitor?

A

Grapefruit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Give examples of drugs that are affected by enzyme induction/inhibition
``` Ciclosporin Citalopram Oral contraceptive Warfarin Phenytoin Protease inhibitors Acetylcholinesterase inhibitors Theophylline Statins COWPATS ```
26
What proportion of the population lack the enzyme to metabolise codeine?
8%
27
What percent of the population are rapid metabolisers of codeine?
1%
28
Why does diazepam have such a short length of activity when it has a long half life of 36 hours?
Distribution - it is highly lipid soluble so lots of it is distributed into fat Has a high volume distribution
29
After how many half lives is the plasma concentration of an administered drug effectively zero?
5 half lives
30
What is clearance?
Volume of plasma cleared of drug per unit time
31
What drugs have zero order kinetics?
Phenytoin Thiopentone Fluoxetine Ethanol
32
What is zero order kinetics?
Enzymes catalysing elimination are in short supply Can be fully saturated if drug given in high dose Plasma concentration - time profile during elimination phase is linear
33
What is Emax?
Maximum possible effect produced by activation of a receptor
34
What is a partial agonist?
Ligand that binds to the same receptor but produces less than a maximal response - has lower intrinsic activity
35
Give examples of partial agonists
Buprenorphine | Salmeterol
36
What drug combination treats bronchospasm?
Beta 2 agonist - salbutamol | Muscarinic antagonist - ipratropium
37
Give an example of a non competitive antagonist
Phenoxybenzamine - used in management of Phaeochromocytoma
38
What makes warfarin, lithium, vancomycin, gentamycin and theophylline dangerous?
Narrow therapeutic index
39
What is telbivudine?
Antiviral drug used in treatment of hep B | Synthetic thymidine nucleoside analogue so impairs DNA virus replication by leading to chain termination
40
What is truvada?
Emtricitabine and tenofovir | Used for HIV pre exposure prophylaxis and treatment
41
Which drugs can cause SIADH?
``` Carbamazepine Sulfonylureas SSRIs Tricyclic antidepressants Vincristine Cyclophosphamide ```
42
What are common adverse effects of thiazide diuretics?
``` Dehydration Postural hypotension Hyponatraemia Hypokalaemia Hypercalcaemia Gout Impaired glucose tolerance Impotence ```
43
What are examples of low dose inhaled corticosteroids and their doses?
Beclometasone dipropionate: 50/100 mcg 2 puffs BD | Fluticasone propionate: 50 mcg two puffs BD
44
What are examples of medium dose inhaled corticosteroids and their doses?
Beclometasone dipropionate: 100/200 mcg 2 puffs BD | Fluticasone propionate: 125 mcg 2 puffs BD
45
What are examples of high dose inhaled corticosteroids and their doses?
Beclometasone dipropionate: 100/250 mcg 4 puffs BD | Fluticasone propionate: 250 mcg 2 puffs BD
46
At what level of GFR should metformin be reviewed/stopped?
If GFR below 45, review dose | If GFR below 30, stop
47
A 69 year old HIV negative man has lamivudine resistant chronic hep B. What is the treatment of choice?
Tenofovir plus entecavir
48
A 42 year old IV drug user is hep C PCR positive. What is the best treatment option?
PEG interferon alpha with ribavirin
49
What type of drug are carbimazole and propylthiouracil?
Thyroid peroxidase inhibitors used in thyrotoxicosis
50
What are indications for warfarin and target INRs for these conditions?
VTE: target 2.5 unless recurrent then 3.5 AF: target 2.5 Mechanical heart valve: target INR depends on type of valve and location
51
What factors may potentiate warfarin?
Liver disease P450 inhibitors: amiodarone, ciprofloxacin Cranberry juice Drugs which displace warfarin from plasma albumin: NSAIDs Drugs which inhibit platelet function: NSAIDs
52
What are side effects of warfarin?
Haemorrhage Teratogenic Skin necrosis: protein c reduced when first starting. Temporary pro coagulant state, avoided by concurrent heparin Purple toes
53
What are major side effects of colchicine?
``` Bleeding Burning in stomach throat or skin Convulsions Diarrhoea Fast shallow breathing Muscle weakness Nausea and vomiting ```
54
What are complications of statins?
Myalgia Myositis Myopathy
55
What is the difference in statin prescription between primary and secondary prevention?
Primary prevention: atorvastatin 20mg OD. If non HDL has not fallen by at least 40% consider titration up to 80mg Secondary: atorvastatin 80mg OD
56
Which drugs make complications of statins more likely?
Fibrate | Immunosuppressants
57
Why can renal failure occur with statins?
Rhabdomyolysis which leads to acute renal failure secondary to myoglobinuria
58
What effect can lithium have on your kidneys that would cause polyuria, polydipsia and high-normal sodium?
Can cause nephrogenic diabetes insipidus
59
What does ergometrine cause and what are possible complications?
Uterine contraction Can cause shock from anaphylactoid reactions HTN MI
60
What is febuxostat and how does it work?
Drug used second line in prevention of gout | Xanthine oxidase inhibitor, reduces uric acid levels in the body
61
Name some drugs which may cause problems in asthmatics
Adenosine: wheeze, bronchospasm Diclofenac Beta blockers Morphine: can cause histamine release
62
Why is unfractioned heparin less frequently used than low molecular weight?
Low molecular weight act specifically on factor Xa and do not require monitoring of APTT Effective for prophylaxis and treatment of VTE and can be used in pregnancy Can be given in once daily doses rather than needing a continuous infusion which is required in unfractioned due to short half life
63
What is the dose of enoxaparine used in STEMI?
IV 3000 units | Then 1mg/kg 12 hourly for up to 8 days
64
What is the dose of enoxaparine used in NSTEMI and unstable angina?
Subcut 1mg/kg 12 hourly for 2-8 days
65
In which patients should initial starting dose of levothyroxine be lower?
Elderly | Ischaemic heart disease
66
After a change in thyroxine dose, how soon should TFTs be performed?
8-12 weeks
67
What should happen to levothyroxine dose in pregnancy?
Increased by at least 25-50 micrograms due to increased demands of pregnancy TSH monitored carefully, aiming for low normal value
68
What are side effects of levothyroxine therapy?
Hyperthyroidism due to over treatment Reduced bone mineral density Worsening of angina Atrial fibrillation
69
What monitoring is required for statins and when?
LFT at baseline, 3 months and 12 months
70
What monitoring is required for ACE inhibitors and when?
U and Es prior to treatment, after increasing dose and at least annually
71
What monitoring is required for amiodarone and when?
TFT, LFT, U and Es, CXR prior to treatment | TFT, LFT every 6 months
72
What monitoring is required for methotrexate and when?
FBC, LFT, U and Es before starting treatment, weekly until stabilised, then every 2-3 months
73
What monitoring is required for azathioprine and when?
FBC, LFT before treatment FBC weekly for first 4 weeks FBC, LFT every 3 months
74
What monitoring is required for lithium and when?
Lithium levels weekly until stabilised then every 3 months | TFT and U and Es prior to treatment then every 6 months
75
What monitoring needs to be done for sodium valproate and when?
LFT and FBC before treatment | LFT periodically in first 6 months
76
Which drug causes red man syndrome?
Vancomycin if rapidly injected
77
Which TB drug can cause peripheral neuropathy? Which drug can be given concomitantly to prevent this?
Isoniazid | Give pyridoxine to prevent
78
What thyroid disorders can be caused by Amiodarone?
Hypothyroidism | Hyperthyroidism
79
Which anti diabetic medications can increase risk of DKA?
SGLT2 inhibitors: canagliflozin, dapagliflozin, empagliflozin
80
What is the most appropriate treatment for hyperthyroidism in pregnancy? What consequence is there in breast feeding?
Carbimazole Propylthiouracil Use at minimum dose as both cross placenta Excreted in small amounts in breast milk, not absolutely contraindicated but not ideal while breastfeeding
81
Which antibiotic is contraindicated in pregnancy due to foetal dental staining?
Tetracyclines
82
What is the risk of giving fluoxetine alongside sulphonylureas?
Hypoglycaemia
83
Give some drug examples which can raise serum lipid concentrations
Beta blockers Thiazide diuretics Systemic retinoids
84
Which cardiology drugs can cause a photosensitive rash?
Amiodarone | Thiazide diuretics
85
How do you calculate a breakthrough dose of morphine?
1/6th dose of daily morphine intake
86
What is the preferred antithyroid drug in pregnancy?
Propylthiouracil - less likely to cross placenta
87
Ah what point should a statin be stopped if it is causing LFT derangement?
If serum transaminase concentrations rise to and persist at 3 times upper limit of reference range
88
What is nicorandil?
Potassium channel activator which has vasodilatory effects on coronary arteries
89
What are side effects of methylphenidate?
Abdominal pain Nausea Dyspepsia
90
How do you convert a dose or oral morphine to diamorphine?
Total daily morphine divided by 3
91
What can precipitate lithium toxicity?
``` Dehydration Renal failure Diuretics (esp bendroflumethiazide) ACE inhibitors NSAIDs Metronidazole ```
92
Which drugs to treat UTI should be avoided in pregnancy?
Trimethoprim avoided in first trimester due to risk of neural tube teratogenicity Nitrofurantoin avoided close to full time due to risk of neonatal haemolysis
93
What are precipitating factors for digoxin toxicity?
``` Hypokalaemia Increasing age Renal failure MI Hypomagnesaemia Hypercalcaemia Hypernatraemia Acidosis Hypoalbuminaemia Hypothermia Hypothyroidism Drugs: amiodarone, verapamil, diltiazem, spironolactone ```
94
What is management for digoxin toxicity?
Digibind Correct arrhythmias Monitor potassium
95
Which antibiotics should be used with caution in patients with epilepsy?
Quinolones: ciprofloxacin, levofloxacin
96
Which anti malarial drugs are safe in pregnancy?
Chloroquine | Proguanil if folate supplement of 5mg OD taken
97
What are side effects of rifampicin?
Hepatitis Orange secretions Flu like symptoms
98
What are side effects of isoniazid?
Peripheral neuropathy (prevent with pyridoxine) Hepatitis Agranulocytosis Liver enzyme inhibitor
99
What are side effects of pyrazinamide?
Hyperuricaemia Arthralgia Myalgia Hepatitis
100
What are side effects of ethambutol?
Optic neuritis | Dose adjust in renal impairment
101
What effects does metoclopramide have?
Increase GI motility Increase sphincter tone Central antiemetic actions through dopamine
102
Which drugs can cause gingival hyperplasia?
Phenytoin Ciclosporin Calcium channel blockers AML
103
Why do PPIs increase risk of fractures?
Malabsorption of calcium and magnesium
104
What is the mechanism of action of quinolones? (Ciprofloxacin)
Inhibit topoisomerase II (DNA gyrase) and topoisomerase IV to prevent DNA synthesis Bactericidal
105
What are adverse effects of ciprofloxacin?
Lower seizure threshold in patients with epilepsy Tendon damage, including rupture Cartilage damage - avoid in children Lengthens QT interval
106
What is the mechanism of action of mifepristone?
Partial agonist of progesterone receptors, blocks their action Inhibits ovulation Sensitises endometrium to action of prostaglandins
107
What are the actions of misoprostol?
Induction of labour/uterine contractions Dilation of cervix Expulsion of products of conception
108
Why is hyperkalaemia a side effect of co trimoxazole?
Inhibits sodium channels in the distal nephron similar to potassium sparing diuretic amiloride
109
What are some adverse effects of finasteride?
Impotence Decreased libido Ejaculation disorders Gynaecomastia and breast tenderness
110
Which antibiotic is associated with aplastic anaemia?
Chloramphenicol
111
Which antibiotic is associated with staining dental enamel?
Tetracyclines eg doxycycline
112
Which antibiotics can cause cartilage erosion and reduce fit potential?
Quinolones and fluoroquinolones e.g. Ciprofloxacin
113
Which antibiotic can cause a metallic taste in the mouth?
Metronidazole
114
What is the mechanism of action of tacrolimus?
Calcineurin inhibitor - reduce activation of nuclear factor of activated T cells (NFAT) which promotes IL2 production
115
What is the mechanism of action of mycophenolate mofetil?
Antimetabolite - interrupt DNA synthesis | Inhibits inosine monophosphate dehydrogenase so prevents purine synthesis
116
What is the mechanism of action of azathioprine?
Antimetabolite - interrupt DNA synthesis Pro drug metabolised to 6mercaptopurine which is inserted into DNA sequence instead of purine, recognised as mismatch and triggers apoptosis
117
What are some associations of advanced maternal age?
``` Miscarriage Chromosomal abnormality HTN Diabetes Prolonged labour Low birth weight Pre term delivery Neonatal mortality ```
118
What is the mechanism of action of demeclocycline? What is it used for?
Vasopressin antagonist Induces free water excretion Treatment for SIADH who fail to respond to fluid restriction
119
What effect do macrolide antibiotics have on statins?
Inhibit metabolism by CYP3A4 | Can lead to myopathy and rhabdomyolysis
120
Why is ciprofloxacin contraindicated in patients under 16 years?
Associated with experimental arthropathy in growing animals
121
Which drugs can cause gingival hyperplasia?
NCP Nifedipine Ciclosporin Phenytoin
122
How many days before surgery should warfarin be stopped?
5 days | INR needs to go below 1.5
123
Which TB drug is associated with visual problems/colour blindness?
Ethambutol
124
What is an equivalent dose of prednisolone if a patient is on 20mg hydrocortisone?
5mg prednisolone | 4:1 ratio
125
What may be side effects of sulfasalazine and therefore what monitoring is required?
Leucopenia Thrombocytopenia Oligospermia Monitor FBC, U and Es, LFTs
126
Why does co trimoxazole cause hyperkalaemia?
Inhibits sodium channels in distal nephron in a similar way to amiloride
127
What are signs of procyclidine overdose?
Agitation Confusion Sleeplessness lasting up to 24 hours or more Pupils dilated and unreactive to light
128
Which drugs can interact warfarin and lead to an increase in INR?
``` O DEVICES Omeprazole Disulfiram Erythromycin Valproate Isoniazid Cimetidine and ciprofloxacin Ethanol Sulphonamides ```
129
Which TB drug is associated with peripheral neuropathy? What is given to counteract this?
Isoniazid | Give pyridoxime
130
Which TB drug used in resistant and atypical cases may cause vertigo?
Cycloserine
131
Which TB drug is a potent hepatic enzyme inducer?
Rifampicin
132
Which drug is useful for speeding up gastric motility in acute migraine?
Metoclopramide
133
Why could bendroflumethiazide precipitate digoxin toxicity?
Could cause hypokalaemia
134
How do you convert a morphine dose from oral to SC?
Divide by 2
135
What are side effects of carbimazole?
Rash Hair loss Agranulocytosis
136
What is the most serious adverse event associated with amiodarone?
Pulmonary toxicity - pneumonitis
137
Why should verapamil not be given in combination with beta blockers?
May cause complete heart block
138
What is the mechanism of action of bupropion?
Noradrenaline and dopamine reuptake inhibitor and nicotinic antagonist
139
What are contraindications to bupropion?
Epilepsy Pregnancy Breastfeeding Eating disorder (relative)
140
What is the mechanism of action of varenicline?
Nicotinic partial agonist
141
What is the recommended course of treatment with varenicline?
12 weeks
142
What are common side effects with varenicline?
Nausea Headache Insomnia Abnormal dreams
143
In which patients should varenicline be used with caution?
History of depression or self harm | Contraindicated in pregnancy and breast feeding
144
What are side effects of amiodarone?
``` Pneumonitis/lung fibrosis Neutropenia Hepatitis Phototoxicity Slate grey skin discolouration Hypothyroidism Hyperthyroidism Arrhythmias Corneal deposits Peripheral neuropathy Myopathy ```
145
Which immunosuppressant drug used to prevent organ rejection can cause new onset diabetes after transplantation?
Tacrolimus - calcineurin inbibitor
146
Which antibiotics can cause photosensitivity?
Doxycycline/tetracycline
147
What is malarone?
Atovaquone/proguanil antimalarial
148
Which opioids are preferred in patients with chronic kidney disease?
Alfentanil Buprenorphine Fentanyl
149
What is the risk of concurrent prescription of methotrexate and trimethoprim?
Marrow aplasia
150
What are problematic side effects of ciprofloxacin?
C diff infection | Enthesitis and tendon rupture
151
Why are ACE inhibitors contraindicated in bilateral renal artery stenosis?
Glomerular filtration pressure dependent on vasoconstriction of the efferent arteriole because the resistance of the afferent blood vessels have been pathologically increased
152
Which is the recommended anti malarial for sub Saharan Africa?
Mefloquine
153
How long before travel does mefloquine need to be started?
2-3 weeks
154
How long before travel does chloroquine/proguanil need to be started?
1 week
155
What is the recommended antibiotic for prophylaxis of meningitis in those who have been exposed?
Ciprofloxacin
156
Which antibiotic is used for prophylaxis of TB in those who are exposed?
Isoniazid for 6 months | Or combo isoniazid and rifampicin for 3 months
157
Which drug can be given to pregnant HIV positive women who wish to reduce risk of transmission to their baby?
Zidovudine
158
What is the mechanism of action of finasteride?
5 alpha reductase inhibitor: prevent conversion of testosterone to active DHT
159
What are side effects of calcium channel blockers?
Headache Flushing Ankle oedema
160
Which drugs may interact with clarithromycin?
Warfarin Aminophylline Statins
161
What is the mechanism of action of varenicline?
Nicotinic receptor partial agonist - reduces cravings and pleasurable effects
162
What is the mechanism of action of bupropion? What is the major risk?
Antidepressant Risk of seizures Noradrenaline dopamine reuptake inhibitor
163
What are side effects of beta blockers?
``` Fatigue Orthostatic hypotension Weakness Blurred vision Stuffy nose Impotence Rash CHF Bradycardia Pulmonary oedema ```
164
What are side effects of calcium channel blockers?
``` Dizziness Headache Redness in the face Fluid build up in the legs Rapid heart rate Slow heart rate Constipation Gingival overgrowth ```
165
What is the mechanism of action of ivabradine?
Acts at funny channels - reduce cardiac pacemaker activity
166
What is advice regarding statins in pregnancy?
Stop them due to congenital abnormality risk
167
What is the mechanism of action of Azathioprine?
Purine analogue | Interrupts DNA synthesis and drives rapidly dividing cells into apoptosis
168
What is the mechanism of action of sirolimus?
Inhibitor of mTOR, mammalian target of rapamycin (protein kinase acting downstream of IL2 signalling to promote proliferation and survival of T cells)
169
What is the mechanism of action of tacrolimus?
Calcineurin inhibitor | Reduces activation of nuclear factor of activated T cells which is a transcription factor that promotes IL2 production
170
What is the interaction between iron and thyroxine?
Iron reduces the absorption of thyroxine
171
What are side effects of sodium valproate?
``` Weight gain Nausea Vomiting Hair loss Easy bruising Tremor Hepatic failure Pancreatitis ```
172
Which beta blocker is safe to use in liver failure?
Propranolol 40mg BD
173
In which patients should caution be used when prescribing sulfasalazine?
G6PD deficiency | Allergy to aspirin or sulphonamides
174
What are adverse effects of sulfasalazine?
``` Oligospermia SJS Pneumonitis Myelosuppresion Heinz body anaemia Megaloblastic anaemia Coloured tears/stained contact lenses ```
175
What is the conversion factor between oral codeine and oral morphine?
Divide by 10
176
What is the generic name for herceptin?
Trastuzumab
177
What are adverse effects of interferon alpha?
Flu like symptoms | Depression
178
Which drugs can cause pancreatitis?
``` Azathioprine Mesalazine Didanosine Bendroflumethiazide Furosemide Pentamidine Steroids Sodium valproate ```
179
Which antihypertensive is associated with rebound HTN following acute withdrawal?
Clonidine
180
Which drug when combined with beta blockers can cause complete heart block?
Verapamil
181
Which drugs are associated with drug induced lupus?
``` Antibodies to tumor necrosis factor-a Anticonvulsants: phenytoin Chlorpromazine D-penicillamine Hydralazine Interferon alfa Isoniazid Methyldopa Minocycline Procainamide ```
182
What is a side effect of minoxidil which is used for benefit in another condition?
Hirsutism - used in regaine topical minoxidil solution for treatment of baldness
183
Which antihypertensive can precipitate haemolysis?
alpha methyldopa
184
Concurrent use of what drug may make clopidogrel less effective?
PPI
185
Which antidiabetic drugs can cause cholestasis?
Sulphonylureas
186
What should be the first line agent in diabetic neuropathic pain?
Duloxetine
187
What is the mechanism of action of adenosine?
Transient heart block in AV node Agonist of A1 receptor which inhibits adenylyl cyclase so reduces cAMP causing hyperpolarisation by increasing outward potassium flux Adenosine has short half life of 8-10secs
188
What are side effects of verapamil?
``` Heart failure Constipation Hypotension Bradycardia Flushing ```
189
What are side effects of nifedipine and amlodipine?
Flushing Headache Ankle swelling
190
In which patient group should mefloquine not be prescribed?
Hx of anxiety, depression, schizophrenia or other psychiatric disorders
191
Which drugs are associated with causing IIH?
``` Oral contraceptive Tetracyclines Nalixidic acid Nitrofurantoin Growth hormone ```
192
What are side effects of cyclosporin?
``` Everything increased Fluid BP Hair Potassium Gums Glucose ```
193
Which acetylcholinesterase inhibitors are recommended by nice for mild to moderate AD?
Donepezil Galantamine Rivastigmine
194
Which drug is used for moderate to severe AD?
Memantine (NMDA antagonist)
195
What are side effects of EPO?
``` Accelerated HTN leading to encephalopathy and seizures Bone aches Flu like symptoms Skin rash Urticaria Pure red cell aplasia Raised PCV increases risk of thrombosis Iron deficiency ```
196
What is the most common cause of drug induced angioedema?
ACE inhibitors
197
What change in eGFR and creatinine is acceptable when starting an ACE inhibitor?
Decrease in eGFR up to 25% | Rise in creatinine up to 30%
198
How does a dose of Azathioprine change if a patient is on allopurinol?
2mg/kg starting dose - but if on allopurinol - give 25% dose
199
What monitoring and counselling should be given to a patient before starting them on Azathioprine?
TPMT (thiopurine methyltransferase): if no activity, can't break down AZA Blood tests - weekly for 4/52, then 3/12 Myelosuppression signs and symptoms: sore throat, unexplained bruising / bleeding Immunosuppressant hence recommend to avoid any live vaccines, but recommend annual flu vaccine Sun exposure – limited or high factor sunscreen
200
What are prescribing options for IBD?
``` Mesalazine (5ASA) suppository/enema Steroids Azathioprine 6 mercaptopurine Methotrexate (crohns only) Infliximab Surgery ```
201
Why are aminosalicylate drugs best given as local preparations for UC?
Absorbed very quickly in small bowel so need mechanism to get it to large bowel
202
Why is sulfasalazine useful for treating UC?
Anti inflammatory 5-ASA attached to Sulphapyridine with a diazo bond Bacteria hydrolyse the diazo bond Means that it isnt broken down so quickly in small bowel so can get to site of action
203
What 2 forms of mesalazine are available?
Coated with Eudragit-S, pH dependent release: Asacol acts from TI onwards Microparticles coated with ethylcellulose: Pentasa acts from duodenum onwards
204
What is the mechanism of action of mesalazine?
Inhibits both cyclo-oxygenase and 5- lipo-oxygenase pathways of arachidonic acid metabolism Reduces inflammatory prostaglandin production and the formation of other chemotactic substances
205
What cautions should be applied when prescribing mesalazine?
Renal impairment Pregnancy and breast feeding Blood disorders can occur: Patients must be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise during treatment Elderly- risk of serious renal toxicity with oral preparations, test renal function initially and every 3 months for first year, then every 6 months for next 4 years and annually thereafter
206
What are contraindications to mesalazine prescription?
Avoid in salicylate hypersensitivity | Severe hepatic impairment
207
Which drugs may interact with mesalazine?
Possible increased risk of leucopenia when aminosalicylates are given with azathioprine or mercaptopurine Preparations that lower stool pH (e.g. lactulose) may prevent release of mesalazine
208
What are some side effects of aminosalicylates?
``` Nausea Diarrhoea Abdominal pain Headache Hepatitis Agranulocytosis Interstitial nephritis Asthma in the salicylate sensitive ```
209
What is the first line immunosuppressant in UC and crohns?
Azathioprine
210
What is the mechanism of action of Azathioprine?
Cytotoxic, antiproliferative immunosuppressant Metabolised to 6-Mercaptopurine (6MP Works by inhibiting purine production (decrease leucocytes)
211
What are side effects of Azathioprine?
Hypersensitivity reactions (including malaise, dizziness, vomiting, diarrhoea, fever, rigors, myalgia, arthralgia, rash, hypotension and interstitial nephrosis) require immediate withdrawal Other main SE seen in 2-3% = hepatitis, pancreatitis, pneumonitis
212
What cautions should be used when prescribing Azathioprine?
Hepatic impairment: may need to reduce dose Renal impairment: may need to reduce dose Reduce dose in elderly Pregnancy: treatment should not be started during pregnancy, but safe to continue treatment during pregnancy if already on it
213
What are contraindications to Azathioprine prescription?
Hypersensitivity to azathioprine or mercaptopurine | Breast feeding
214
Which drugs does Azathioprine interact with?
Allopurinol: enhances effect and toxicity of azathioprine, Reduce dose of AZA when allopurinol is given concurrently Aminosalicylates: possible increased risk of leucopenia Anticoagulants: reduces anticoagulant effects of coumarins Antibacterials: risk of toxicity of azathioprine is enhanced with rifampicin, co- trimoxazole and trimethoprim
215
What are long term risks with use of 6 mercaptopurine?
Lymphoma | Non melanotic skin cancers- Use of suncreams
216
What is the mechanism of action of methotrexate?
Anti-metabolite folic acid inhibitor Prevents DNA synthesis and cell division by preventing synthesis of purines and thymydilate. As rapidly dividing cells require thymydilate to synthesise DNA, MTX halts division Suppression of immune system, improving disease Immunosuppressant and anti-inflammatory activity
217
What are side effects of methotrexate?
``` Nausea Diarrhoea Stomatitis Leucopenia Pneumonitis Hepatitis Liver fibrosis ```
218
What monitoring needs doing when on methotrexate?
Monitor FBC, U+E’s and LFT’s at baseline and every 2-4 weeks until treatment stabilised
219
What are some cautions and contraindications for methotrexate use?
``` liver and renal disease alcohol obesity diabetes infections pregnancy breast feeding ```
220
Who is eligible for biologic drugs according to nice guidelines?
``` Severe active Crohn’s disease / UC AND Refractory to immunomodulatory drugs / can nottolerate side effects / experienced toxicity AND Surgery inappropriate (UC) Very good drugs for fistulising disease ```
221
What is TNF alpha?
Pro-inflammatory cytokine Binds to TNF-alpha receptors on target cells inducing variety of local and systemic effects TNF Causes local Inflammation in GI tract: diarrhoea, malabsorption Presumed to be CD4 subset of T cells mediating disease
222
What are side effects of infliximab infusion?
Human anti-chimeric Ab formation can develop Acute hypersensitivity reactions can occur Symptoms – fever, chills, pruritus, urticaria, chest pain, hypo/hypertension, dyspnoea Each infusion requires P & BP every 30 mins and access to resuscitation equipment If mild reaction – slow down / temporarily stop infusion, If severe – stop and give IV hydrocortisone Delayed hypersensitivity reactions can occur: Fever, rash, myalgia, arthralgia, Up to 2 weeks post infusion More likely if >12 weeks between infusions Antibody formation can lead to reduced response to infliximab
223
Why is adalimumab usually better tolerated by younger patients than infliximab?
Can be given subcut rather than infusion
224
What are possible complications of biologic drugs for IBD?
Possible risk of lymphoma and malignancy: Increased if pt on other immunosuppressants Infectious complications (VZV, candida): Serious in 3% TB reactivation (PPD (purified protein derivative) and CXR required prior to treatment) Interactions tacrolimus / live vaccines
225
What are contraindications to biologic therapy?
``` Sepsis Significantly raised LFTs (x3) Hypersensitivity to infliximab Active TB Pregnancy, avoid for 6 months after Breast Feeding, stopping treatment ```
226
What cautions should be applied in prescribing biologic therapy?
``` Previous TB Hepatic Impairment Renal Impairment Heart Failure Mouse allergies > 14 weeks since last infusion ```
227
Which drugs can cause SIADH?
Carbamazepine Sulphonylureas SSRIs TCAs
228
When should calcichew be prescribed if being used as a phosphate binder?
With meals
229
How should EPO be prescribed?
By brand
230
What is a key pharmacodynamic parameter in dosing of aminoglycosides?
Cmax: minimum inhibitory concentration ratio | Therefore once daily dosing is appropriate as it keeps this ratio high enough for longer than multiple lower doses
231
What is the key pharmacodynamic parameter in dosing beta lactam antibiotics?
Time antibiotic concentration remains above the MIC of organism expressed as T > MIC So aim is to maximise duration of exposure
232
Where are bugs located that aminoglycosides are good at killing?
Circulating microorganisms
233
Where are bugs located that beta lactams are good at killing?
Soft tissue Bone and joints Lungs CSF
234
Which graph is used to look at gentamicin levels?
Hartford Nomogram
235
When should gentamicin levels be checked? What level is required for further dose to be given?
24 hours post dose | Pre dose level 1mg/L or less
236
Why might a patient's gent levels be high?
Blood collected too early Patient not clearing Gentamicin Blood collected from lumen used to infuse Gentamicin earlier on
237
Which bugs are targeted by vancomycin?
Gram-positive bacteria including MRSA
238
What vancomycin levels are required for monitoring?
Collect serum specimen 30 minutes or less before next dose Frequency of collection: First level at steady state (3rd - 5th dose)– Subsequent levels once or twice/week More frequently if renal function changing or concurrent nephrotoxic drugs
239
Which are the safest drugs in renal and liver failure?
Beta lactams
240
Which antibiotic drugs are cell wall synthesis inhibitors?
Beta Lactam agents: Penicillins, Cephalosporins, Carbapenems, Beta-lactamase inhibitors Glycopeptides
241
What is a minimum inhibitory concentration?
Lowest concentration of antimicrobial required to prevent visible growth after overnight incubation
242
What is the minimum bactericidal concentration?
Lowest concentration of antimicrobial required to kill bacteria
243
Which antibiotic drugs are protein synthesis inhibitors?
Aminoglycoside: Blocks binding of amino acid charged t-RNA to acceptor site; Miss reading of m-RNA Tetracycline: Blocks binding of amino acid charged t-RNA to acceptor site Chloramphenicol: Block growth of peptide chain by interfering with peptidyl transferase Macrolides: Interfere with translocation of t-RNA on bacterial ribosome preventing further peptide elongation
244
What are aminoglycosides mainly used for? (Gent, streptomycin)
Used primarily to treat infections with Gram negative bacilli or in synergic combination with cell wall active antimicrobial agents against some resistant Gram positive bacteria
245
What are features of aminoglycoside antibiotics?
Bactericidal Poorly absorbed orally, so only parenteral (and topical) Penetrates poorly into CSF, bone, eye, prostate, lung, biliary tract even in inflammation Toxicity to VIII nerve (irreversible, occur even after discontinuation, cumulative with repeated courses) Gentamicin mainly vestibular, Amikacin mainly auditory and kidney (reversible)
246
How can bugs become resistant to antibiotics?
Enzymatic inactivation /destruction of drug: beta lactamase, Penicillinase, Carbapenemase Modification/bypass of target site Drug efflux
247
What is the mechanism of action of mirtazapine?
Blocks alpha 2 adrenergic receptors which increases release of neurotransmitters - noradrenaline and serotonin
248
What are 2 important side effects of mirtazepine that can be used for benefit?
Sedation | Increased appetite
249
In a patient on aspirin/nsaid, what else needs adding if they are to be started on an SSRI?
Add PPI to reduce GI bleed risk
250
How does amiodarone cause hyper and hypothyroidism?
Hypothyroidism: interferes with conversion of T4 to T3 Hyperthyroidism: thyroiditis, donation of iodine
251
What does highly active anti retroviral therapy involve?
``` Combination of at least 3 drugs Usually 2 nucleoside reverse transcriptase inhibitors and either a protease inhibitor or a non nucleoside reverse transcriptase inhibitor NRTI: zidovudine, lamivudine NNRTI: nevirapine, efavirenz Protease inhibitor: ritonavir, indinavir ```
252
What are side effects of NRTIs?
Peripheral neuropathy Zidovudine: anaemia, myopathy, black nails Didanosine: pancreatitis
253
What are side effects of NNRTIs?
P450 enzyme interaction - inducer | Rash
254
What are side effects of protease inhibitors?
``` Diabetes Hyperlipidaemia Buffalo hump Central obesity P450 enzyme inhibition ```
255
Who should receive statins?
All people with established CV disease (stroke, TIA, IHD, peripheral arterial disease) 10 year CV risk 10% or more including type 2 diabetics Type 1 diabetics diagnosed more than 10 years ago or aged over 40 or have established nephropathy
256
What are major side effects of anti malarial medications?
Atovaquone and proguanil (malarone): GI upset Chloroquine: headache, contraindicated in epilepsy Doxycycline: photosensitivity, oesophagitis Mefloquine: dizziness, neuropsychiatric disturbance, contraindicated in epilepsy
257
What are pharmacological management options for postural hypotension?
Fludrocortisone | Midodrine

Phase 3 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions