PSA/pharmacology Flashcards

Question

What is tamsulosin? | What side effects does it cause?

Answer 1

An alpha 1 antagonist used to treat BPH | Postural hypotension, drowsiness, dyspnoea, cough

Answer 2

Used to treat BPH | Causes postural hypotension

Answer 3

``` spironolactone (most common drug cause) cimetidine digoxin cannabis finasteride GnRH agonists e.g. goserelin, buserelin oestrogens, anabolic steroids ```

Answer 4

``` Increased appetite Weight gain Alopecia- regrowth may be curly P450 enzyme inhibitor (may affect warfarin INR- INR increases) Ataxia Tremor Hepatitis Pancreatitis Thrombocytopaenia Teratogenic (neural tube defects) ```

Answer 5

``` P450 enzyme inducer dizziness and ataxia drowsiness leucopenia and agranulocytosis syndrome of inappropriate ADH secretion visual disturbances (especially diplopia) ```

Answer 6

Steven Johnson syndrome

Answer 7

``` P450 enzyme inducer Dizziness and ataxia Drowsiness Gingival hyperplasia Hirsutism Coarsening of facial features Megaloblastic anaemia Peripheral neuropathy Enhanced vit D metabolism causing osteomalacia Lymphadenopathy ```

Answer 8

Isosorbide mononitrate is a nitrate drug used in the management of angina pectoris. It is a vasodilator that acts on both arteries and veins. Venous vasodilation reduces venous return to the heart and therefore preload which reduces the oxygen requirement of the myocardium. The arterial vasodilation results in a reduction in systemic vascular resistance and improved coronary blood flow. Nitrate tolerance is a phenomenon whereby patients experience reduced therapeutic effects due to the continuous use of nitrate drugs. This can be overcome by ensuring the patient's blood-nitrate concentrations fall to a low level for 4-12 hours of the day. This is achieved by 'asymmetric dosing' which means giving a dose in the morning and a dose in the mid-afternoon, rather than giving it 12-hourly. This means the patient will have a period of time overnight where there is a lower level of nitrates in their blood, which should minimise tolerance. Asymmetric dosing is only a requirement for the standard-release formulation. Modified-release preparations are available that are given once daily.

Answer 9

``` SICKFACES.COM Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol Clarithromycin Erythromycin Sulphonamides Ciprofloxacin Omeprazole Metronidazole Grapefruit juice ```

Answer 10

``` SSSCRAPG Sulphonylureas St jogns wort Smoking CARBAMAZEPINE Rifampicin Alcohol (chronic use) Phenobarbital Phenytoin Griseofulvin ```

Answer 11

It can be remembered by 'ILACKOP' Insulin (varies between hospitals) Lithium- day before Anticoags/antiplatelets- variable and can sometimes continue during surgery

Answer 12

In patients who are bleeding, at risk of bleeding or have suspected bleeding. Prophylactic heparin is contraindicated in acute ischaemic stroke due to the risk of bleeding into the stroke. Also important to remember that erythromycin can increase warfarin's effect (and hence prothrombin time0 and INR despite stable dose)

Answer 13

``` STEROIDS... S- Stomach ulcer T- thin skin E- Edema R- Right and left heart failure O- Osteoporosis I- Infection D- Diabetes (steroids raise blood glucose) S- Cushings SYNDROME ```

Answer 14

``` N= No urine output (renal failure) S= Systolic dysfunction A= Asthma I= Indigestion D= Distorted clotting ```

Answer 15

Hypotension (including postural) that may result from all groups of antihypertensives Bradycardia may occur with some CCBS and beta blockers Electrolyte disturbance occurs with ACE-I and diuretics Individual drugs have specific side effects....... - ACE-I= dry cough - Beta blockers= wheeze in asthmatics and also worsening of acute heart failure - CCBS= peripheral oedema and flushing - Diuretics can cause renal failure, loop diuretics (Furosemide) can also cause gout, K+ sparing diuretics can cause gynaecomastia.

Answer 16

First assess the patient Secondly look at the chart Thirdly look at the bloods- U and ES.

Answer 17

Metaclopramide is a pro kinetic and a dopamine receptor antagonist, therefore avoid in bowel obstruction, avoid in parkinsons It can cause acute dystonia

Answer 18

They work by blocking the muscarinic receptors from the neurotransmitter acetylcholine, this is released from the cholinergic nerve endings in the airways. They inhibit the parasympathetic nervous system Side effects= confusion/drowsiness, dry skin, constipation, urinary retention, dry mouth, palpitations, blurred vision, increased intraocular pressure

Answer 19

In heart failure as it can cause fluid retention

Answer 20

Duloxetine

Answer 21

a) No regular but can prescribe paracetamol PRN b) Paracetamol regularly, codeine 30mg up to 6 hourly oral c) Co-codamol if severe pain, 2 tablets 6 hourly oral or morphine sulfate as required

Answer 22

Domperidone, despite them both being dopamine antagonists, metoclopramide crosses the blood brain barrier and so exacerbated parkinsonian symptoms by acting on central dopamine receptors domperidone does not cross the BBB so is safer to use in Parkinson's disease

Answer 23

They reduce the potassium excretion in the kidneys due to reduction of production of aldosterone

Answer 24

Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection from acid, it is therefore at risk of influencing inflammation and ulceration

Answer 25

They inhibit gastric epithelial renewal

Answer 26

Trimethoprim, as they are both folate antagonists | This can lead to bone marrow toxicity- pancytopaenia and neutropenic sepsis

Answer 27

If patient is septic

Answer 28

They shouldn't be given any prophylactic heparin as it increases the risk unnecessarily

Answer 29

Normally sub cut, incept in variable rate where it is IV.

Answer 30

Clozapine is an antipsychotic (Atypical) and the most worrying side effects (for which all patients are monitored with at least monthly blood tests) is agranulocytosis, resulting in neutropoenia When there is agranulocytosis and neutropoenia, it requires immediate cessation of the drug and referral to haematology

Answer 31

Hb WCC Platelets

Answer 32

Bacterial infection Steroids Tissue damage (inflammation, infarct and malignancy)

Answer 33

Viral infection Chemotherapy or radiotherapy Clozapine (Antipsychotic) Carbimazole (antithyroid)

Answer 34

Viral infection Lymphoma Chronic lymphocytic leukaemia

Answer 35

Their fluid status

Answer 36

3DS Dehydration Drugs Drips (too much IV saline)

Answer 37

``` TAILS Thalassaemia Anaemia of chronic disease IRON DEFICIENCY ANAEMIA Lead poisoning Sideroblastic ```

Answer 38

Anaemia of chronic disease Acute blood loss Haemolytic anaemia Renal failure (Chronic)

Answer 39

B12/Folate deficiency (megaloblastic anaemia) Excess alcohol Liver disease (including non alcoholic causes) Hypothyroidism Haematological diseases beginning with M- myeloproliferative, myelodysplastic, multiple myeloma

Answer 40

Can be split into: reduced production and increased destruction Reduced production- Infection (usually viral) Drugs- penicillamine ie: in RA treatment Myelodysplasia, myelofibrosis, myeloma Increased destruction- Heparin Hypersplenism DIC ITP (idiopathic thrombocytopenic purpura) Haemolytic uremic syndrome/ thrombotic thrombocytopenic purpura

Answer 41

This is where antibodies are made against the platelets (GPIIb/IIIa receptor) Occurs in children and in pregnancy ``` Symptoms Acutely Usually occurs commonly after a viral infection with bruising and bleeding Epistaxis Mucosal bleeding Purpuric rashes Easy or spontaneous bruising ``` Chronically Splenomegaly (spleen eats more platelets) Ix- FBC, blood films (fewer platelets), LFTS (tell the bone marrow to make the platelets), TFTS, IgA deficiency It is a disease of exclusion

Answer 42

Situation in which haemostasis starts to run out of control, when this happens lots of blood vessels form in different organs leading to organ ischaemia (coagulation uses up platelets and clotting factors), paradoxically it causes too little and too much clotting at the same time.

Answer 43

Reactive; bleeding, tissue damage (infection, malignancy, inflammation), post splenectomy Primary: myeloproliferative disorders

Answer 44

A) diuretics and fluid loss (D+V) | Addison's disease

Answer 45

SIADH, psychogenic polydipsia, hypothyroidism

Answer 46

``` Heart failure Renal failure Liver failure Nutritional failure Thyroid failure (hypothyroidism can be euvolaemic too) ```

Answer 47

``` S= Small cell lung cancer I= infection A= Abscess D= drugs (carbamazepine and antipsychotics) H= Head injury ```

Answer 48

Drugs (loop and thiazide diuretics) I= inadequate intake or intestinal loss (D+V) R= renal tubular acidosis E= endocrine (cushings and conns syndromes)

Answer 49

DREAD Drugs- K+ sparing diuretics and ACE-I Renal failure Endocrine (Addisons) Artefact (very common, due to clotted sample) DKA (when insulin is given to DKA the potassium drops requiring regular hourly monitoring +/- replacement)

Answer 50

Either renal failure or upper GI Bleed | If a patient has a raised urea but they are not dehydrated then look at their Hb (may be an upper GI bleed)

Answer 51

70% are prerenal= Get a rise in urea is greater than the creatinine rise Caused by dehydration, sepsis, blood loss, renal artery stenosis Intrinsic renal 10%= Urea rise is less than the creatinine rise Intrinsic can be caused by acute tubular necrosis causing ischaemia Nephrotoxic antibiotics, ACE-I/NSAIDS, Radiological contrast, rhabdomyolysis, Gout (negatively bifringement crystals), Inflammation, cholesterol emboli ``` Post renal 20%= Urea rise is less than creatinine rise Stone Tumour BPH, prostate cancer, aneurysm ```

Answer 52

Gentamicin Tetracyclines (doxycycline) Vancomycin

Answer 53

Indicates prehepatic jaundice that is rarely due to any liver problem itself

Answer 54

``` May indicate posthepatic jaundice Any fracture Liver damage Cancer Pagets disease of bone Pregnancy Hyperparathyroidism Osteomalacia Surgery ```

Answer 55

A) Haemolysis B) fatty liver, hepatitis, cirrhosis, malignancy, heart failure, Wilsons disease/haemochromatosis C) Stone, drugs causing cholestasis, tumour, primary biliary cirrhosis, sclerosing cholangitis, pancreatic or gastric cancer and lymph node

Answer 56

Levothyroxine dose is changed according to the TFT results for patients with hypothyroidism, TSH is used as a guide and the range required= 0.5-5IU/L If TSH range is <0.5 then decrease the dose If TSH range is 0.5-5 then keep it at the same dose If TSH range is >5 then increase the dose of thyroxine

Answer 57

Confusion, nausea, visual halos and arrhythmias

Answer 58

Early: Coarse tremor Intermediate: tiredness Late: Arrhythmias, seizures, coma, renal failure, diabetes insipidus

Answer 59

``` Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy Teratogenecity ```

Answer 60

Ototoxicity and nephrotoxicity

Answer 61

Ototoxicity and nephrotoxicity

Answer 62

You measure the concentration 1 hour post dose to get the peak Normal range in IE= 3-5 Normal range in everything else= 5-10 You measure the concentration just before the next dose to get the trough Normal in IE <1 Normal in everything else is <2

Answer 63

You should stop the drug, potentially give an alternative, give supportive care ie: fluids, and give antidote if one is available!

Answer 64

``` ABC and O2 by non rebreathe mask Remove the cause ASAP i.e.: blood transfusion Adrenaline 500 micrograms of 1:1000 IM Chlorphenamine 10mg IV Hydrocortisone 200mg IV Asthma tx if wheeze Amend drug chart allergies box ```

Answer 65

``` ABC 100% by non rebreather mask Salbutamol (%mg NEB) Hydrocortisone 100mg IV (severe/ life threatening) or prednisolone (40-50mg if moderate) Ipratropium (500 micrograms NEB) Theophylline (Only if life threatening) ```

Answer 66

Same treatment as asthma, but add antibiotics if infective exacerbations Patients are also more likely to have type 2 respiratory failure, so use high flow oxygen will case If in peri arrest; apply high flow oxygen 28% oxygen is a safe starter in patients if they are not in peri arrest, ABG 30 mins later to assess the effect

Answer 67

The pt has underlying lung disease They always need treatment: chest drain if >2cm or SOB or if >50 years old Otherwise aspirate

Answer 68

If <2cm rim and not SOB then discharge with OP follow up in 4 weeks If >2cm rim on CXR or feels SOB then aspirate and if unsuccessful aspirate again, and if still unsuccessful aspirate again and then if still unsuccessful chest drain

Answer 69

Give all patients 0.9% saline (normal saline, a crystalloid), unless the patient… 1) is hypernatraemic or hypoglycaemic (give 5% dextrose instead) 2) has ascites- give human albumin solution instead, the albumin maintains oncotic pressure; furthermore the higher sodium content of 0.9% saline will worsen ascites 3) is shocked from bleeding- give blood transfusion but a crystalloid first if no blood available

Answer 70

If tachycardia or hypotensive then give 500ml bolus immediately (‘haemodynamically unstable’), after bolus given then reassess the patient especially HR, BP and urine output to assess response and speed of next IV fluid bag If only oliguric (<0.5ml/kg/hour) then give 1L over 2-4 hours then reassess the patient

Answer 71

As a general rule… Adults require 3L (but be wary of night time) Elderly require 2L Adequate electrolytes are given by 2 sweet 1 salty 1L 0.9% Nacl followed by 2L 5% dextrose Add potassium to the two dextrose bags (20mmol in each bag) K+ intake should be 0.5mmol/L

Answer 72

It depends on how much you are giving… If you are giving 2L per day= 12 hourly bags If you are giving 3L per day= 8 hourly bafs

Answer 73

It means they are taking 30mg codeine and 500mg paracetamol

Answer 74

Pupillary dilation Loss of accommodation Dry mouth Tachycardia (after a transient bradycardia)

Answer 75

``` Acute intracranial event Infection Electrolyte disturbance Constipation Urinary retention ```

Answer 76

Diazepam Tramadol!!!! (Should be avoided unless absolutely necessary) Cyclizine= antiemetic which can cause drowsiness and confusion, reduced doses are recommended in the elderly

Answer 77

NSAIDS and ibuprofen should be used with caution in patients on methotrexate due to increased risk of nephrotoxicity Trimethoprim

Answer 78

Dihydrocodeine and paracetamol | 2 tablets contain 500mg paracetamol each

Answer 79

In active infection

Answer 80

No, it could cause a rebound tachycardia

Answer 81

If the distance between the clavicles and the spinous process is equal then there is no rotation.

Answer 82

The 7th rib should transect the diaphragm

Answer 83

A to E High flow O2 Antibiotics (amoxicillin for CAP, co amoxiclav for HAP), paracetamol, IV fluids if haemodynamically unstable

Answer 84

``` A to E High flow oxygen Morphine 5-10mg IV Cyclizine 50mg IV DOAC If low BP- IV fluid bolus, contact ITU, consider thrombolysis ```

Answer 85

``` A to E Cannulae 2 large bore Catheter and strict fluid monitoring Crystalloid bollus Cross match 6 units of blood Correct clotting abnormalities (terlipressin in varices) (tranexamic acid in Lower GI bleed) ```

Answer 86

``` A to E High flow oxygen IV fluid 4-10mg dexamethasone IV unless severely immunonocompromised LP (+/- CT head) ``` 2g cefotaxime IV If immunocompromised or >55y/o add 2g ampicillin IV (give antibiotics pre LP if having CT head or prolonged LP) Consider ITU

Answer 87

Ensure the airway is patent and put in recovery position with oxygen to prevent aspiration if patient vomits and perform bedside tests for provoking factors (plasma glucose, electrolytes, drugs and sepsis) If the seizure lasts for more than 5 minutes

Answer 88

``` Co careldopa (levodopa + carbidopa) Co beneldopa (levedopa + benserazide) ```

Answer 89

Dopamine agonist- ropinirole or monoamine oxidase inhibitor (rasagiline)

Answer 90

A) valproate for males and levetiracetam for females B) valproate for males or lamotrigine for females C) carbamazepine or lamotrigine D) ethosuximide or valproate E) valrproate for males and lamotrigine for females

Answer 91

If mild/moderate then treat with acetylcholinesterase (AChE) inhibitors However they are only started by specialist doctors There are currently 3 licensed- donepezil, rivastigmine and galantamine If moderate or severe dementia then treat with NDMA antagonist (memantine)

Answer 92

Offer treatment and support the pt stopping smoking Offer pneumococcal and influenza vaccinations Offer pulmonary rehabilitation if indicated Co develop a personalised self management plan Optimise treatment for co morbidities Offer SABA or SAMA to use as needed if the above interventions have been offered and inhaled therapies are needed to relieve breathlessness and exercise limitation and people have been trained to use inhalers and can demonstrate satisfactory technique Offer SABA or SAMA to use as needed If the person is limited by symptoms or has exacerbations despite treatment then offer LABA and LAMA if no asthmatic features If asthmatic features or steroid responsive then consider LABA + ICS

Answer 93

Prednisolone 20-40mg daily orally and treat a severe flare with IV hydrocortisone 100-500mg three to four times daily or as required (as per BNF) IV and supportive care (IV fluid, NBM, antibiotics)

Answer 94

Azathioprine or active agent 6-mercaptopurine | 6 mercaptopurine is metabolized to inactive components by the enzyme TPMT

Answer 95

Mercaptopurine and azathioprine because if there is a deficiency in TPMT then it would lead to abnormal accumulation of 6- mercaptopurine and azathioprine This would increase the risk of liver and bone marrow toxicity. If TPMT is found to be low (but not deficient or ansent) then start lower dose azathioprine If TPMT levels are deficient/absent then give methotrexate instead

Answer 96

Docusate sodium and arachis oil (rectal) | Good for faecal impaction; reduced gut motility

Answer 97

Senna, bisacodyl | Cant use them in acute abdomen and may exacerbate abdominal cramps

Answer 98

Lactulose Phosphate enema Phosphate enema cant be used in acute abdomen, IBD May exacerbate bloating

Answer 99

Treated started by specialists typically usung methotrexats followed by additional DMARDS During a flare… Short term glucocorticoids- IM methylprednisolone 80mg Short term NSAIDS ie: ibuprofen 400mg 8 hourly with gastro protection (lansoprazole) Re-instate DMARDS if dose previously reduced After failure to respond to two DMARDS, sverely active RA may be managed with TNF alpha inhibitors ie: infliximab

Answer 100

GI infection- norovirus and C difficile gastroenteritis

Answer 101

Loperamide or codeine

Answer 102

In the morning to prevent disruption of sleep

Answer 103

Zopiclone but you don’t really want to give it in the elderly

Answer 104

Tell her she should attend hospital straight away if she notices leg swelling, pain or redness.

Answer 105

In the morning with breakfast

Answer 106

1-2 weekly blood tests to monitor full blood count

Answer 107

Weekly, once INR is stabilised then monthly blood tests can be performed

Answer 108

Acute alcohol intoxication causes enzyme inhibition whereas chronic causes enzyme induction

Answer 109

Kidney function and potassium should be measured 1-2 weeks after initiation of ACE-Is, particularly if they have CKD

Answer 110

Steroids increase diabetes mellitus- regularly check blood glucose They increase the risk of osteoporisis- therefore bisphosphonate should be commenced There is an increased risk of gastric irritation and ulceration in steroid therapy, therefore offer PPI omeprazole Dont stop sterids suddenly- can cause addisonian crisis Pts on steroids are at risk of hypertension

Answer 111

It can take up to 6 weeks to have an improvement in symptoms Citalopram makes you more photosensitive and precautions should be taken in sunlight Pts may feel worse immediately after starting antidepressants before they improve SSRIS can cause a dry mouth Make them aware of serotonin syndrome (dilated pupils, dilated pupils, loss of muscle co ord and twitching muscles, insomnia, confusion, agitation or restlessness).

Answer 112

1g in 100ml or 10mg in 1ml | 1g in 100g for weight/weight calculations

Answer 113

``` GTN spray (glyceryl trinitrate) 2 sprays sublingual ```

Answer 114

Short acting insulin (actrapid/novorapid) with glucose | Normally give 10 units actrapid in 100ml of 20% dextrose over 30 min IV

Answer 115

A) metformin | B) sulphonylurea

Answer 116

Serum creatinine as clearance of vancomycin is reduced in patients with renal dysfunction Therefore renal function must be taken into account when choosing a dosing regime The two classic side effects are nephrotoxicity and ototoxicity

Answer 117

They are contraindicated when the liver function tests are three times the normal range LFTs should be taken before starting, at 3 months and at 12 months

Answer 118

No its checked if the patient is at increased risk of myopathy

Answer 119

Should be performed weekly after initiation and after each dose change until the concentratioms are stable, and then 3 months therafter

Answer 120

Sodium depletion

Answer 121

There is a risk of cirrhosis!

Answer 122

Blood glucose as hyperglycaemia and diabetes ca occur in patients prescribed antipsychotic drug, fasting blood glucose must be tested at baseline and regular intervals thereafter.

Answer 123

LFTs, sodium valproate is associated with hepatotoxicity

Answer 124

FBC for the first 18 weeks

Answer 125

Beta blockers

Answer 126

Statins after 3 months should lead to >40% reduction in non HDL cholesterol >40% reduction then continue the current dose < or equal to reduction then consider increasing the dose

Answer 127

LFTs ALT and other LFTs are known to increase with the use of statinsb ALT increase of >1 to <3x of upper limit of normal then continue statin and recheck the LFTs in 4-6 weeks If the LFTs increase more than or equal to 3x of normal then stop statin (ezotimibe) Creatine kinase CK is known to increase with the use of statins If the CK is more than or equal to 5x normal limit then stop the statin