PSA/Pharm Flashcards by Federico Ciardi

what is the treatment for acute dystonia/oligouric crisis?

procyclidine 10 mg iv STAT

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what cardiovascular medications are contraindicated in peripheral vascular disease?

all - beta-blockers because they reduce peripheral limb perfusion through action on the adrenergic system

severe PVD - also avoid ACE-I

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what are some commonly used mediations that worsen congestive heart failure?

calcium-channel blockers
NSAIDs
DPP-4 inhibitors (sitagliptin)
alpha-blockers (doxazosin)
anti-arrhythmics (sotalol, flecanide, disopyramide)

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name the commonly used thiazides and thiazide-like diuretics

bendroflumethiazide
hydrochlorothiazide
indapamide
chlorthalidone
metolazone

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name the common used cardioselective calcium channel blockers

verapamil
diltiazem

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name the common peripherally acting calcium channel blockers

amlodipine
nifedipine
nimodipine

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which antibiotics should be avoided when a patient is on methotrexate?

trimethoprim and fluroquinolones

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what medication seriously increased the risk of myotoxicity when given in combination with a statin?

gemfibrozil

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what should be checked before starting a patient on spironolactone or eplerenone?

serum potassium

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what should be told to patients on methotrexate?

blood disorders (infections, bleeding, anaemia, ulcers)
liver toxicity (dark urine, nausea and vomiting)
respiratory effects (shortness of breath)
NSAIDs - should be avoided, but not absolutely CI
teratogenicity - both men and women should be on contraception for the duration of treatment and 3 months after stopping

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which NSAIDs have the highest and lowest CV risk associated?

highest - coxibs and diclofenac

lowest - naproxen

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what is the mechanism of action of thiazide diuretics?

what are the common side effects of thiazide diuretics?

inhibiting sodium reabsorption in the distal convoluted tubule through the Na-Cl symporter. potassium is lost as a result of more Na reaching the DCT and collecting ducts

common:

dehydration & postural hypotension
hyponatraemia, hypokalaemia, hypercalcaemia
gout
impotence

rare:

photosensitive rash
thrombocytopenia
agranulocytosis
pancreatitis

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what are the main serious side effects of NSAIDs?

worsening of asthma
increased risk of thromboembolic (MI or CVA) events
increased risk of GI-ulceraiton and haemorrhage
- worsened if drinking alcohol in moderate quantities concurrently

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what are the fluid and electrolyte requirements for an adult in 1 day?

what is the minimum urine output target?

fluid - 40 mL/kg

Na+ - 2 mmol/kg

K+ - 1 mmol/kg

0.5 mL/kg/hour

…do not exceed an infusion rate of 10 mmol/hr K+

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what a suitable dose of any LMWH for treatment of VTE?

what are the treatment doses of rivaroxaban and apixaban for VTE?

enoxaparin - 1.5 mg/kg OD s/c every day until adequate oral anticoagulation is established

rivaroxaban - 15 mg BD for 21 days taken with food

apixaban - 10 mg BD for 7 days, then 5 mg BD

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what medication can lead to gingival hyperplasia?

ciclosporin

phenytoin

CCBs

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what are the starting and monitoring requirements for warfarin?

what finding would be a contraindication to starting warfarin?

measure PT and baseline LFTs, do not hold off the first dose while waiting for PT to come back from the lab
measure the PT and calculate the INR

PT > 5 x ULN then do not use warfarin

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what are the monitoring requirements for methotrexate?

what are the side effects?

what is the conception advice?

what drugs should be avoided while on methotrexate?

low-dose = LFTs
high-dose = LFTs and FBC and U&E

myelosupression, liver cirrhosis, pulmonary fibrosis, pneumonitis, mucositis

*women**: avoid pregnancy for at least 3 months following MTX therapy
*men:** use effective contraception for at least 3 months following MTX therapy

trimethoprim and co-trimoxazole (TMP/SMX)

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what are the monitoring requirements for lithium?

what are the target and acceptable levels?

lithium levels - check every 3 months, taken 12 hours after last dose (trough)

TFTs and U&E checked every 6 months

*target**: 0.8-1.0
*acceptable:** 0.4-1.2

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what blood test is used to monitor 5-aminosalycylic acids (5-ASAs)?

U&Es

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what are the side effects common to sulfa drugs?

rashes
oligospermia
headache
Heinz body anaemia
megaloblastic anaemia
lung fibrosis

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what are the side effects common to 5-ASA drugs?

GI disturbance
agranulocytosis
pancreatitis
- mesalazine >>> sulphasalazine
interstitial nephritis

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what are the adverse affects of amiodarone?

what are the monitoring requirements?

slate-grey appearance
thyroid dysfunction
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis (ALT > AST)
photosensitivity
thrombocytopenia at injection sites
bradycardia
*prior to treatment:** TFTs, LFTs, U&E, CXR
*every 6 months:** TFTs and LFTs

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what is the impact of NSAIDs on heart failure?

NSAIDs worsen heart failure by causing fluid retention, increasing blood pressure and increasing the afterload on an already strained heart

heart failure worsened by NSAIDs

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why should 5% glucose not be given to an alcoholic at risk of wernicke's encephalopathy immediately?

when malnourished, all the glucose in the body is diverted to the brain for energy. thiamine is a co-factor for OxPhos. introducing systemic glucose increases the whole body demand for thiamine, so it is diverted away from the brain, leading decreased cerebral oxidative phosphorylation. fill the patient up with thiamine (Pabrinex) first, then give glucose

what are the starting and monitoring requirements of statin medications?

get lipid profile (obviously) and LFT before starting LFTs at 3 and 12 months after starting AST/ALT is more than 3x ULN, stop and restart at a lower dose transaminase rise of less than 3x ULN - do not stop medication

what is the rare but serious liver side effect of statins?

cholestatic hepatitis (raised ALP and liver damage)

which diuretic worsens gout?

thiazides

which antibiotics increase the chances of statin-induced myopathy?

macrolides - erythromycin/clarithromycin

what proportion of patients will not tolerate AZA therapy? what are the common side effects? what is the uncommon and serious side effect of AZA? what medication should you try next in a patient with IBD?

33% of patients will not tolerate AZA GI side effects, hair loss and skin rash red cell aplasia, pancytopenia 6-mercaptopurine

what is the side effect of AZA that is more likely to occur in patients with low TMPT levels/deficiency?

myelosupression

which tests are needed if you suspect digoxin toxicity?

ECG and renal function (looking for raised creatinine or hypokalaemia) digoxin level *though there is no absolute number for this. the likelihood of toxicity increases as concentrations rise, but toxicity is indicated by the degree of hypokalaemia*

which drugs are directly hepatotoxic? i.e. give raise transaminases without ALP rise

paracetamol overdose statins rifamipicin

which drugs give a cholestatic hepatitis?

co-amoxiclav and flucloxacillin nitrofurantoin steroids sulfonylureas

what is the rule for calculating the expected PaO₂ from the FiO₂?

[FiO₂ - 10] = expected PiO₂

what medication can result in a downward-sloping ST segment depression in all leads?

digoxin

what are the main ototoxic drugs?

* aminoglycosides * loop diuretics * platinum-based chemotherapy

which medication should be avoided in myasthenia gravis?

anti-cholinergics.. i.e. oxybutynin for urinary incontinence

when should thiazides be taken?

in the morning if you prescribe at night then the patient will wake up having to pee

what is the dosing schedule for common anti-emetics?

metoclopramide and cyclizine given **TDS/8-hourly**

which is the anti-emetic dopamine blocker than can be used in parkinson's disease?

domperidone, as it does not cross the BBB metaclopramide should not be used in Parkinson's

what are the common drugs that precipitate bronchospasm in asthmatics?

beta-blockers, NSIADs and adenosine note: 10-20% of asthmatics are sensitive if they've been on it before without a problem then they can stay on NSAIDs risk is increased in patients who are middle-aged or those with nasal polyps

what is the definition and treatment of a severe flare of UC?

opening bowels \>6 times/day and systemically unwell IV hydrocortisone 100 mg QDS/6-hourly

what is the definition of a major bleed on warfarin? i.e. requiring PCC

bleeding causing hypotension or into a confined space (skull)

what are the sick day rules for T1DM patients with regards to insulin?

needs to increase the dose of insulin, otherwise will run a higher risk of DKA

after how many days should you review the antibiotic therapy for acute otitis media?

5 days

after how many days should you review the antibiotic therapy for acute epiglottitis?

3 days

what is first line treatment for GAD?

citalopram/escitalopram/fluoxetine

what is the first line treatment for depression in adults?

citalopram/escitalopram/fluoxetine/fluvoxamine/paroxetine

what is the monitoring requirement before you start valproate?

liver function tests

what is the monitoring requirement for clozapine?

FBC checked weekly for at least the first 18 weeks

what is the monitoring for phenytoin?

ECG and blood pressure

what is the best marker to monitor the response of a pneumonia to antibiotic therapy?

respiratory rate return to normal indicates that the respiratory failure is resolved. ABG would be preferable, but is invasive so RR is often easiest

which diuretic is associated with hyponatraemia?

thiazides

dose for paracetamol?

1g qds

dose for ibuprofen?

200-400 mg tds

dose for codeine?

30-60 mg qds

dose for co-codamol?

8/500 mg qds 30/500 qds or 'co-codamol 8/500 mg 2 tablets qds'

dose for cyclizine?

50 mg tds

dose for metaclopramide?

total 30-100 typically 10 mg tds

amoxicillin

500 mg tds

dose for clarithromycin

500 mg bd

dose for lansoprazole

15-30 mg od

dose for omeprazole

20-40 mg od

dose for aspirin

secondary prevention 75 mg od treatment 300 mg od

dose for clopidogrel

75 mg od secondary prevention 300 mg od treatment

dose for simvastatin

10-80 mg **ON** start at 40 mg ON if the patient has diabetes or established atherosclerotic cardiovascular disease

dose for atenolol

25-100 mg od

dose for ramipril

1.25-10 mg od

dose for bendroflumethiazide

2.5 mg od give in the morning!

dose for furosemide

20 mg od - 80 mg bd can be much higher for renal patients

dose for amlodipine

5-10 mg od

dose for levothyroxine?

25-200 mcg od

dose for metformin?

500 mg od - 1 g bd

which drugs worsen seizure control in patients with epilepsy?

* alcohol, cocaine, amphetamines * cirpfloxacin, levofloxacin * aminophylline, theophylline * bupropion * methylphenidate * mefenamic acid

what is the rule for dose of oral morphine for breakthrough pain in palliative care?

take 1/6th of daily oral morphine dose for breakthrough pain

which opioids are best used in renal impairment?

fentanyl or oxycodone

what is the effect of ciclosporin on electrolytes?

hyperkalaemia hyperglycaemia and hyperuricaemia

how do you treat vulvovaginal candidiasis? what is the difference in pregnancy?

topical/PV clotrimazole must be prolonged treatment... 7 days usually rather than a single dose

T1DM in DKA usually on a basal-bolus what do you do with their regular insulin? is the treatment with fixed-rate or variable-rate insulin for the DKA?

stop the short acting keep the long-acting insulin as normal start them on fixed-rate insulin of 0.1 U/kg/hr

what is the advice for patients when treating with loperamide for acute diarrhoea?

loperamide should be taken after each loose stool care not to exceed the maximum dose (16 mg/24 hrs)

what is the dose adjustment of insulin when a T1DM patient starts taking steroids for treatment of another disease?

increase the dose by 10%