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Final year > PSA pharmacology > Flashcards

PSA pharmacology Flashcards

1
Q

What 2 pharmacological VTE prophylaxis agents should be used in surgical patients with renal impairment?

A

LMWH or unfractionated heparin

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2
Q

What antibiotic is an enzyme inhibitor and can dangerously increase levels of warfarin?

A

erythromycin

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3
Q

Name the py450 inducers. CRAP GPS

A

Carbamezepine
Rifampicin
Alcohol (chronic)
Phenytoin

Griziofulvin (antifungal)
Phenobarbitol (barbiturate used in anxiolytic, hypnotic and anti convulsant)
Sulphonylurea

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4
Q

Name the py450 inhibitors.

SICKFACES.COM

A 
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol (binge)
Chloramphenicol
Erythromycin
Sulphonamides
Ciprofloxacin
Omeprazole
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5
Q

Wich is an enzyme inducer and which is inhibitor?

a) St Johns wort
b) Grapefruit juice

A

a) enzyme inducer

b) enzyme inhibitor

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6
Q

What drug class must be continued during surgery, due to difficulties in mounting response to surgery if not? and why?

A

long term steroids!!

adrenal atrophy when on steroids so dose should be continued+IV steroids given

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7
Q

Name the drugs needing to be stopped before surgery. I LACK OP

A 
Insulin
Lithium
Antiplatelets/anticoags
COCP/HRT
K sparing duiretics
Oral hypoglycaemics
Perindopril (and other ACE-i)
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8
Q

What is indapamide?

A

thiazide diuretic

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9
Q

What kind of diuretic is furosemide?

A

loop diuretic

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10
Q

Name 2 K+ sparing diuretics.

A

spironolactone

amiloride

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11
Q

Which oral hypoglycaemic must be stopped before surgery due to it’s risk of lactic acidosis? Also, what should be used instead of OH/insulin?

A

Metformin

Insulin sliding scale

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12
Q

Which antihypertensive classes can cause renal impairment? Name 3

A

ACE-i
Calcium channel blockers
B blockers

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13
Q

What is the max amount of K+ that should be given in an hour?

A

10mmol/hour

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14
Q

What anticoag should NOT be given in acute ischaemic stroke and why?

A

heparin due to potential for bleeding into stroke

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15
Q

Name some SE and thus CI of steroids using the mnemonic STEROIDS.

A 
Stomach ulcer
Thin skin
Edema
R&L HF
Osteoporosis
Infection
Diabetes
Syndrome (cushings)
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16
Q

Name some SE and thus CI of NSAIDS using the mnemonic NSAIDs.

A 
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)
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17
Q

Which NSAID is NOT CI in asthma, renal failure or HF?

A

aspirin

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18
Q

What SE can ALL antihypertensives cause? be obvious

A

hypOtension

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19
Q

Which 2 antihypertensive classes cause bradycardia?

A

b blocker

Ca2+ blocker

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20
Q

Which 2 antihypertensive classes cause electrolyte abnormalities? Which causes hypERkalaemia?

A

ACE-i (causes hyperkalaemia)
diuretic
b blockers

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21
Q

Name the main SE in:

a) ACE-i (1)
b) B blockers (2)
c) Ca2+ blockers (1)
d) diuretic (1)

A

a) cough
b) wheeze in asthma, worsen HF
c) peripheral oedema
d) renal failure

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22
Q

Diuretic SE:

a) loop (furosemide)
b) K+ sparing (sprinolactone, amiloride)

A

a) gout

b) gynaecomastia

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23
Q

When giving antiemetics, are the doses different or the same, depending on route of administration?

A

SAME

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24
Q

Give an example of 3 bags of fluids needed for maintenance in a normal adult. Over how long would you give each bag?

A

1 salty, 2 sweet!
1L 0.9% saline
2x 5% dextrose

24/3=8 hours

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25
Q

How many litres of fluid would you give an elderly person in a day. Over how many hours would you give each bag?

A

2L

24/2=12 hours

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26
Q

What 3 generic things should you check before giving fluids?

A

U&E levels
signs of overload-raised JVP, peripheral/pulmonary oedema
Ensure patient does not have palpable and thus obstructed bladder (i.e. this could be the cause of reduced urine output!)

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27
Q

What do most patients receive when admitted to hospital to prevent VTE? Name 2 things and an example of the drug given
Which patient should NOT receive TED stockings?

A

compression TED stockings
LMWH (e.g. dalteparin 5000U SC) or enoxaparin

Peripheral arterial disease (usually have absent pedal pulse)

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28
Q

What drug is the most commonly used anti emetic? What alternative is used in HEART FAILURE patients?

A

cyclizine 50mg

metoclopramide 10mg used in HF

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29
Q

Which 2 situations should metoclopramide be avoided as an anti emetic?

A

Parkinsons-as metoclopramide is dopamine antagonist

Young females-may cause acute dyskinesia

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30
Q

What does 30/500 mean in the drug co-codamol 30/500?

A

there is 30mg codeine and 500mg paracetemol in each tablet

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31
Q

What is the max dose of paracetemol allowed per day?

A

4grams

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32
Q

Give an example of a prescription for mild pain-include regular and as required examples.

A

Regular PO paracetemol up to 1g every 6 hours PLUS

As required PO codeine 30mg up to 6hour

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33
Q

Give 2 first line treatments of neuropathic pain.

A

amitriptyline and pregabalin

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34
Q

What drug is used in diabetic neuropathy pain?

A

duloxetine

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35
Q

Explain the effects of NSAIDS and ACE-i/ARB’s on the afferent and efferent arterioles of the kidney, respectively.

A

Afferent-NSAIDS release prostaglandins which constrict arteriole=kidney damage and reduced flow
Efferent-ACE-i/ARB’s dilates efferent can protect in normal conditions or causes damage if blood flow to kidney is low

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36
Q

Which 2 classes of drugs predispose to dyspepsia and GI ulceration?

A

NSAIDS

Steroids

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37
Q

What class of pain relief drugs cause constipation?

A

opioids

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38
Q

Which drug class causes myalgia?

A

statins

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39
Q

Name 3 common SE of ca2+ blockers.

A

peripheral oedema
flushing
headache and dizziness

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40
Q

Name 3 common SE of ACE-i.

A

cough
hyperkalaemia
renal failure

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41
Q

What disease can NSAID use exacerbate?

A

asthma

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42
Q

Which medication can cause pancytopenia and neutropenic sepsis and therefore should be stopped if a patient has sepsis?

A

methotrexate-antifolate causing reduced cell formation

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43
Q

Which two drugs can exacerbate asthma?

A

NSAID

Beta blockers

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44
Q

What is the most common route for insulin administration?

Which situation do you give insulin IV and is it a long acting or short acting?

A

SC

Sliding scale-short acting

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45
Q

Which two classes of antihypertensives should not be administered together, due to the risk of bradycardia and hypotension?

A

Ca2+ blockers and b blockers

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46
Q

To figure out the cause of anaemia, after looking at Hb levels, what other result will help narrow your differential?

A

Mean cell volume

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47
Q

Name the 4 D’s-causes of hypernatraemia

A

Drugs
Drips
Dehydration
Diabetes insipidus

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48
Q

Name the 5 causes of Microcytic anaemia

A 
Thalassaemia 
Anaemia of chronic disease 
I iron deficiency anaemia
L lead poisoning
S sideroblastic anaemia (genetic disorder-body has enough iron but but cannot incorporate into Hb)-dx with blood film showing ringed sideroblasts
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49
Q

Name For causes of normocytic anaemia

A

Anaemia of chronic disease
Chronic renal failure
Acute blood loss
Haemolytic anaemia

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50
Q

Name five causes of macrocytic anaemia

A 
B12/Folate deficiency
Excess alcohol use
Hypothyroidism
Liver disease
Haematological disease
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51
Q

Name the two most common causes of B12 deficiency

A 
Pernicious anaemia (AI destruction of GI system,reducing intrinsic factor and thus reduces absorption of B12)
Poor dietary intake
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52
Q

Which three situations do you get high lymphocyte levels?

A

Viral infection lymphoma and chronic lymphocytic leukaemia

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53
Q

Which two drugs cause neutropenia?

A

Clozapine and carbimazole

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54
Q

Which group of patients are at high risk of neutropenia and what should be given urgently?

A

Chemotherapy and radiotherapy patients

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55
Q

Name a drug that causes Thrombocytopenia.

A

Heparin

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56
Q

Name three causes of hypovolaemic hyponatraemia.

A

Fluid loss through diarrhoea and vomiting
Addison’s disease
Diuretics

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57
Q

Name three causes of euvolemic hyponatraemia.

A

SIADH and hypothyroidism and psychogenic polydipsia

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58
Q

Name four causes of hypovolaemic hyponatraemia.

A 
Renal failure
Heart failure
Liver failure
Nutritional failure
Hypothyroidism
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59
Q

Name four causes of hyporkalaemia using the mnemonic DIRE.

A

Drugs
Inadequate intake/intestinal loss (D+V)
Renal tubular acidosis
Endocrine (cushings and conns syndrome)

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60
Q

Name five causes of hyperkalaemia using the mnemonic DREAD.

A 
Drugs
Renal failure
Endocrine (addisons)
Artefact (clotted sample)
DKA
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61
Q

What does a raised urea without a raise of creatinine indicate and why?

A

upper GI bleed
Urea is a breakdown product of amino acids such as globin chains in Hb
Look at Hb to help determine if it is presence of upper GI bleed

62
Q

Name three causes of pre-renal AKI and what biochemical disturbance is seen in regards to urea and creatinine.

A

Dehydration and shock (Sepsis blood loss anaphylaxis)
Urea^^^
Creatinine <> or ^

63
Q

Name three causes of intrinsic renal AKI and what biochemical disturbance is seen in regards to urea and creatinine.

A 
Ischaemia causing acute tubular necrosis
Nephrotoxic antibiotics such as gentamicin Vancomycin and Tetracycline
Drugs such as NSAIDS and ACE inhibitors
Contrast
Rhabdomyolysis
Inflammation such as vasculitis

Urea <> or ^
Creatinine ^^^

64
Q

Name three causes of Post-renal AKI and what biochemical disturbance is seen in regards to urea and creatinine.

A

In lumen: stone
In wall: tumour, fibrosis
External: BPH, prostate ca

65
Q

If billirubin is raised on its own without changes in liver function tests what is this most likely to signify?

A

Red-cell haemolysis

66
Q

Name six causes of raised ALP using their mnemonic ALKPHOS.

A 
Any fracture
Liver damage
Kancer
Pagets disease of bone/pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
67
Q

If a patient with hypothyroidism is on levothyroxine what hormone level do use to adjust the dose of the drug?

A

TSH

68
Q

Name four causes of raised bilirubin and AST/ALT

A 
Fatty liver
hepatitis
cirrhosis
mailgnancy
wilsons/haemochromatosis
Heart failure
69
Q

Which three Viruses cause hepatitis?

A

Hep A-E
CMV
EBV

70
Q

Which three drugs cause hepatitis?

A

Paracetamol statins and rifampicin

71
Q

Name Six drugs with a narrow therapeutic index.

A 
theophylline
digoxin
gentamicin
warfarin
vancomycin
lithium
phenytoin
diamorphine/heroin
levothyroxine
carbamezepine
72
Q

Name four features of digoxin toxicity.

A

arrhythmia confusion visual halos Nausea

73
Q

Name four features of lithium toxicity.

A

Tremor than tiredness then seizures comas arrhythmia renal failure

74
Q

Name two features of gentamicin and vancomycin toxicity.

A

ototoxicity and nephrotoxicity

75
Q

What is the treatment for breathlessness and oedema in heart failure?

A

furosemide IV injection

76
Q

Name 2 drugs used first line to reduce morbidity and mortality in heart failure patients.

A

ACE-i

B blockers

77
Q

Common SE of b blocker.

A

erectile dysfunction

78
Q 
Which 2 drugs should be withheld until renal function recovers?
allopurinol
aspirin
bisoprolol
candesartan
omeprazole
A

allopurinol

candesartan

79
Q

Name 4 SE of ace-i. HARD

A

Hyperkalaemia
Angioedema
Rash
Dry cough

80
Q

Name 3 drug causes of hypoglycaemia.

A

Insulin
Metformin
quinidine
B blockers

81
Q

2 drugs causing agranulocytosis.

A

carbimazole

clozapine

82
Q

What is a marker of ace-i working?

A

exercise tolerance

83
Q

Name 4 SE of ace-i. HARD

A

Hyperkalaemia
Angioedema
Rash
Dry cough

84
Q

What 2 abx do you give in neutropenic sepsis?

A

gentamicin and tazocin

85
Q

2 drugs causing agranulocytosis.

A

carbimazole

clozapine

86
Q

What time of day to take statins?

A

nighttime

87
Q

3 drugs causing hyponatremia?

A

bendroflumethiazide
ACE-i
SSRI
carbamezepine through SIADH

88
Q

What time of day to take bisphosphonates?

A

before breakfast sitting upright

89
Q

Name 3 SE of bisphosphonates.

A

hypercalaemia
Osteonecrosis of jaw
Atypical stress fractures of hip

90
Q

What % decrease in LDL cholesterol is needed to stop change in dose?

A

40%

91
Q

how do you measure response to abx?

A

measure CRP

92
Q

How do you treat abx induced c difficile. which abx cause it?

A

metronidazole

ceftriaxone, cefotaxime, clindamycin, clarythromycin, ciprofloxacin

93
Q

What are 3 facts about methotrexate?

A

teratogenic
can cause pnemonitis (rare)
narrow ther window
requires monitoring with FBC, LFT, U&E

94
Q

How often do you start giving gentamicin? How is it different in endocarditis and renal failure?

A

once daily
endocarditis: 8 hourly
renal failure: 12 hourly

95
Q

how do you measure response to abx?

A

measure CRP

96
Q

Why shouldn’t you give azathioprine with allopurinol?

A

6 mecaptopurine will build up in toxic doses

97
Q

What are 3 facts about methotrexate?

A

teratogenic
can cause pnemonitis (rare)
narrow ther window
requires monitoring with FBC, LFT, U&E

98
Q

How often do you start giving gentamicin? How is it different in endocarditis and renal failure?

A

once daily
endocarditis: 8 hourly
renal failure: 12 hourly

99
Q

What does NAC replenish stores of?

A

glutathione which metabolises NAPQI

100
Q

How do you reverse unfractionated heparin in overdose?

A

protamine sulphate

101
Q

What to do with warfarin dose if:
a) INR <6
b) 6-8 INR
c) INR >8
How should you give vit K if minor bleeding occurs?
If major bleeding occurs, what other product should be given?

A

a) reduce dose
b) omit warfarin for 2 days then reduce
c) omit warfarin and give 1-5mg oral vit k

If minor bleeding with INR>5 give IV instead of PO

Prothrombin complex

102
Q

First line antidepressant:

a) adult
b) child

A

a) sertraline

b) fluoxetine

103
Q

What anti epileptic should you NOT give in pregnancy and which should be used instead?

A

DO NOT GIVE sodium valproate

Give lamotrigine instread

104
Q

Name 3 SE of b blockers

A 
erectile dysfunction
AKI
Bradycardia
Wheeze due to bronchospasm
Hypotension
105
Q

Name 3 teratogenic medications.

A 
Ace-i
Sodium valproate
Phenytoin
Isotretanoin
Trimethoprim (1st trimester only)
Methotrexate
Lithium
Carbimazole
Warfarin (1st trimester)
106
Q

First line antidepressant:

a) adult
b) child

A

a) sertraline

b) fluoxetine

107
Q

what is used to treat post herpetic neuralgia?

A

topical lidocaine patch

108
Q

Name 3 SE of b blockers

A 
erectile dysfunction
AKI
Bradycardia
Wheeze due to bronchospasm
Hypotension
109
Q

What do you give in:

a) PT/aPTT >1.5x normal range
b) PT/aPTT >1.5x normal range with warfarin
c) platelets<50x10^9/L and active bleeding

A

a) FFP
b) prothrombin complex (beriplex)
c) platelet transfusion

110
Q

When addisonian patients become ill, what should be done with their steroids?

A

increased dose

111
Q

what is used to treat post herpetic neuralgia?

A

topical lidocaine patch

112
Q

How should you treat a patient with a CURB-65 score of:

a) <1
b) 2-3
c) >3

A

a) home treatment
b) hospital rx with PO/IV abx
c) ITU admission

113
Q

What side effect can you get with B blockers that contraindicate their use in a patient with weak pulses and peripheral ulcers?

A

contraindicated in PAD

114
Q

Name 3 drugs that can predispose you to vaginal thrush?

A

amoxicillin
clarithromycin
prednisolone

115
Q

How do you treat acute dystonia?

A

procyclidine hydrochloride

116
Q

What is white coat HTN and how is this avoided?

A

high BP due to anxiety of being in medical environment

Avoided with ambulatory/home monitoring

117
Q

What are the target BP measurements for patients with HTN:
a) under 80
b) over 80?
and how does it differ with home monitoring levels?

A

a) 140/85 but 135/85 at home

b) 150/85 and 145/85 at home

118
Q

B blockers+thiazides used to treat HTN should be avoided in what patients?

A

those with/at risk of diabetes

119
Q

In resistant HTN, name an example of an alpha blocker given.

A

Doxazosin

120
Q

In a HTN crisis (BP>180/110 +organ damage) name 2 drugs that can be given IV.

A

sodium nitroprusside
labetalol hydrochloride
hydralazine hydrochloride

121
Q

What medication should be given in an AF patient with a CHA2DS2-VASc score of:

a) 0
b) 1
c) 2 or more

A

a) aspirin 75mg daily
b) aspirin or warfarin with target INR 2.5
c) warfarin with target 2.5

122
Q

What 4 situations is rhythm control preferred over rate control in AF?

A
  • first presentation
  • drug cause of AF
  • young
  • symptomatic
123
Q

What anti-arrhythmic should not be given to patients with ischaemic/structural heart disease and what should be given instead?

A

do not give flecanide and DO give amiodarone

124
Q

What is the preferred treatment of atrial flutter?

A

catheter ablation

125
Q

If a LABA is inadequate in step 3 of asthma treatment, increase of steroid dose + what two other options can be considered?

A

leukotriene receptor antagonist (montelukast)

theopylline

126
Q

Name 3 smoking cessation techniques.

A

smoking cessation clinic
nicotine replacement patch
drugs-varenicline/bupropion

127
Q

Name 2 drug classes that cause peripheral oedema.

A

Ca2+ blockers

NSAIDS

128
Q

What is the first and second line rx for c diff infection?

A

1st: metronidazole PO
2nd: vancomycin PO

129
Q

Should long acting insulin be continued when giving rx for DKA?

A

YES, stop short acting

130
Q

What should be measured to monitor response to diuretics?

A

weight

131
Q

Give 2 examples of drugs that can be given in severe parkinsons.
Name 2 for mild parkinsons.

A

co-beneldopa and co-careldopa

ropinirole and rasagiline

132
Q

Name 3 drugs used in moderate dementia.

Name the drug used in severe dementia.

A

donepezil, rivastigmine, galantamine

memantine

133
Q

What 2 drugs can be given, alongside supportive care, to induce remission in crohn’s disease?

A

prednisolone and hydrocortisone

134
Q

What drug is used for maintaining remission in crohns and what alternative should be used if patients have a lo level of a particular enzyme?

A

azathioprine which metabolises into 6-mecaptopurine
This is metabolised by TPMT into inactive components

If patient has low levels of TPMT, give methotrexate instead

135
Q

What 2 drugs are used to treat RA?

What extra 2 drugs are given in a flare?

A

methotrexate+DMARD (sulfasalazine, hydroxychloroquine)

In flare give: methypred IM and NSAIDS+PPI

136
Q

If patient fails to respond to DMARDS in RA, what should be given as last resort?

A

TNF alpha inhibitors

e.g. infliximab

137
Q

what drug can be administered as antipyretic?

A

paracetemol

138
Q

What 2 drugs can you give in chronic diarrhoea?

A

loperamide

codeine

139
Q

If a hypnotic is needed for insomnia, which should be given first?

A

zopiclone

140
Q

Which 2 drugs cause parkinsonian symptoms?

A

metoclopramide

haloperidol

141
Q

which 2 diabetic meds can increase risk of hypoglycaemia?

A

insulin

gliclazide

142
Q

what 2 things can methotrexate and trimethoprim cause?

A

nephrotoxicity

myelosupression

143
Q

What condition causes a raised ESR to occur?

A

polymyalgia rheumatica

144
Q

Name 3 SE of SSRI’s

A

photosensitivity
suicidal ideation initially
dry mouth

145
Q

How many weeks may go by before SSRI’s become useful?

A

6 weeks

146
Q

What is a diabetics target HbA1c?

A

<48mmol/mol

147
Q

Name 3 drug classes that cause liver dysfunction.

A

NSAIDS
Diuretics
ACE-i

148
Q

Name 5 signs of chronic liver disease.

A

GAPS JCS

Gynecomastic
Ascites
Peripheral oedema
Splenomegaly

Jaundice
Clubbing
Spider Naevi

149
Q

What abx can cause hepatitis?

A

flucloxicillin

150
Q

Name 5 drug causes of hepatitis that are not dose dependent (like paracetamol).

A 
NSAIDS
Abx (co amox, fluclox)
TB drug (rifampicin)
methotrexate
amiodarone

Final year (8 decks)

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