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
2
Q
What antibiotic is an enzyme inhibitor and can dangerously increase levels of warfarin?
A
erythromycin
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
4
Q
Name the py450 inhibitors.
SICKFACES.COM
A
Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (binge) Chloramphenicol Erythromycin Sulphonamides Ciprofloxacin Omeprazole
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
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
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)
8
Q
What is indapamide?
A
thiazide diuretic
9
Q
What kind of diuretic is furosemide?
A
loop diuretic
10
Q
Name 2 K+ sparing diuretics.
A
spironolactone
amiloride
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
12
Q
Which antihypertensive classes can cause renal impairment? Name 3
A
ACE-i
Calcium channel blockers
B blockers
13
Q
What is the max amount of K+ that should be given in an hour?
A
10mmol/hour
14
Q
What anticoag should NOT be given in acute ischaemic stroke and why?
A
heparin due to potential for bleeding into stroke
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)
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)
17
Q
Which NSAID is NOT CI in asthma, renal failure or HF?
A
aspirin
18
Q
What SE can ALL antihypertensives cause? be obvious
A
hypOtension
19
Q
Which 2 antihypertensive classes cause bradycardia?
A
b blocker
Ca2+ blocker
20
Q
Which 2 antihypertensive classes cause electrolyte abnormalities? Which causes hypERkalaemia?
A
ACE-i (causes hyperkalaemia)
diuretic
b blockers
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
22
Q
Diuretic SE:
a) loop (furosemide)
b) K+ sparing (sprinolactone, amiloride)
A
a) gout
b) gynaecomastia
23
Q
When giving antiemetics, are the doses different or the same, depending on route of administration?
A
SAME
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
25
How many litres of fluid would you give an elderly person in a day. Over how many hours would you give each bag?
2L
| 24/2=12 hours
26
What 3 generic things should you check before giving fluids?
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!)
27
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?
compression TED stockings
LMWH (e.g. dalteparin 5000U SC) or enoxaparin
Peripheral arterial disease (usually have absent pedal pulse)
28
What drug is the most commonly used anti emetic? What alternative is used in HEART FAILURE patients?
cyclizine 50mg
metoclopramide 10mg used in HF
29
Which 2 situations should metoclopramide be avoided as an anti emetic?
Parkinsons-as metoclopramide is dopamine antagonist
| Young females-may cause acute dyskinesia
30
What does 30/500 mean in the drug co-codamol 30/500?
there is 30mg codeine and 500mg paracetemol in each tablet
31
What is the max dose of paracetemol allowed per day?
4grams
32
Give an example of a prescription for mild pain-include regular and as required examples.
Regular PO paracetemol up to 1g every 6 hours PLUS
| As required PO codeine 30mg up to 6hour
33
Give 2 first line treatments of neuropathic pain.
amitriptyline and pregabalin
34
What drug is used in diabetic neuropathy pain?
duloxetine
35
Explain the effects of NSAIDS and ACE-i/ARB's on the afferent and efferent arterioles of the kidney, respectively.
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
36
Which 2 classes of drugs predispose to dyspepsia and GI ulceration?
NSAIDS
| Steroids
37
What class of pain relief drugs cause constipation?
opioids
38
Which drug class causes myalgia?
statins
39
Name 3 common SE of ca2+ blockers.
peripheral oedema
flushing
headache and dizziness
40
Name 3 common SE of ACE-i.
cough
hyperkalaemia
renal failure
41
What disease can NSAID use exacerbate?
asthma
42
Which medication can cause pancytopenia and neutropenic sepsis and therefore should be stopped if a patient has sepsis?
methotrexate-antifolate causing reduced cell formation
43
Which two drugs can exacerbate asthma?
NSAID
| Beta blockers
44
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?
SC
Sliding scale-short acting
45
Which two classes of antihypertensives should not be administered together, due to the risk of bradycardia and hypotension?
Ca2+ blockers and b blockers
46
To figure out the cause of anaemia, after looking at Hb levels, what other result will help narrow your differential?
Mean cell volume
47
Name the 4 D's-causes of hypernatraemia
Drugs
Drips
Dehydration
Diabetes insipidus
48
Name the 5 causes of Microcytic anaemia
```
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
```
49
Name For causes of normocytic anaemia
Anaemia of chronic disease
Chronic renal failure
Acute blood loss
Haemolytic anaemia
50
Name five causes of macrocytic anaemia
```
B12/Folate deficiency
Excess alcohol use
Hypothyroidism
Liver disease
Haematological disease
```
51
Name the two most common causes of B12 deficiency
```
Pernicious anaemia (AI destruction of GI system,reducing intrinsic factor and thus reduces absorption of B12)
Poor dietary intake
```
52
Which three situations do you get high lymphocyte levels?
Viral infection lymphoma and chronic lymphocytic leukaemia
53
Which two drugs cause neutropenia?
Clozapine and carbimazole
54
Which group of patients are at high risk of neutropenia and what should be given urgently?
Chemotherapy and radiotherapy patients
55
Name a drug that causes Thrombocytopenia.
Heparin
56
Name three causes of hypovolaemic hyponatraemia.
Fluid loss through diarrhoea and vomiting
Addison's disease
Diuretics
57
Name three causes of euvolemic hyponatraemia.
SIADH and hypothyroidism and psychogenic polydipsia
58
Name four causes of hypovolaemic hyponatraemia.
```
Renal failure
Heart failure
Liver failure
Nutritional failure
Hypothyroidism
```
59
Name four causes of hyporkalaemia using the mnemonic DIRE.
Drugs
Inadequate intake/intestinal loss (D+V)
Renal tubular acidosis
Endocrine (cushings and conns syndrome)
60
Name five causes of hyperkalaemia using the mnemonic DREAD.
```
Drugs
Renal failure
Endocrine (addisons)
Artefact (clotted sample)
DKA
```
61
What does a raised urea without a raise of creatinine indicate and why?
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
Name three causes of pre-renal AKI and what biochemical disturbance is seen in regards to urea and creatinine.
Dehydration and shock (Sepsis blood loss anaphylaxis)
Urea^^^
Creatinine <> or ^
63
Name three causes of intrinsic renal AKI and what biochemical disturbance is seen in regards to urea and creatinine.
```
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
Name three causes of Post-renal AKI and what biochemical disturbance is seen in regards to urea and creatinine.
In lumen: stone
In wall: tumour, fibrosis
External: BPH, prostate ca
65
If billirubin is raised on its own without changes in liver function tests what is this most likely to signify?
Red-cell haemolysis
66
Name six causes of raised ALP using their mnemonic ALKPHOS.
```
Any fracture
Liver damage
Kancer
Pagets disease of bone/pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
```
67
If a patient with hypothyroidism is on levothyroxine what hormone level do use to adjust the dose of the drug?
TSH
68
Name four causes of raised bilirubin and AST/ALT
```
Fatty liver
hepatitis
cirrhosis
mailgnancy
wilsons/haemochromatosis
Heart failure
```
69
Which three Viruses cause hepatitis?
Hep A-E
CMV
EBV
70
Which three drugs cause hepatitis?
Paracetamol statins and rifampicin
71
Name Six drugs with a narrow therapeutic index.
```
theophylline
digoxin
gentamicin
warfarin
vancomycin
lithium
phenytoin
diamorphine/heroin
levothyroxine
carbamezepine
```
72
Name four features of digoxin toxicity.
arrhythmia confusion visual halos Nausea
73
Name four features of lithium toxicity.
Tremor than tiredness then seizures comas arrhythmia renal failure
74
Name two features of gentamicin and vancomycin toxicity.
ototoxicity and nephrotoxicity
75
What is the treatment for breathlessness and oedema in heart failure?
furosemide IV injection
76
Name 2 drugs used first line to reduce morbidity and mortality in heart failure patients.
ACE-i
| B blockers
77
Common SE of b blocker.
erectile dysfunction
78
```
Which 2 drugs should be withheld until renal function recovers?
allopurinol
aspirin
bisoprolol
candesartan
omeprazole
```
allopurinol
| candesartan
79
Name 4 SE of ace-i. HARD
Hyperkalaemia
Angioedema
Rash
Dry cough
80
Name 3 drug causes of hypoglycaemia.
Insulin
Metformin
quinidine
B blockers
81
2 drugs causing agranulocytosis.
carbimazole
| clozapine
82
What is a marker of ace-i working?
exercise tolerance
83
Name 4 SE of ace-i. HARD
Hyperkalaemia
Angioedema
Rash
Dry cough
84
What 2 abx do you give in neutropenic sepsis?
gentamicin and tazocin
85
2 drugs causing agranulocytosis.
carbimazole
| clozapine
86
What time of day to take statins?
nighttime
87
3 drugs causing hyponatremia?
bendroflumethiazide
ACE-i
SSRI
carbamezepine through SIADH
88
What time of day to take bisphosphonates?
before breakfast sitting upright
89
Name 3 SE of bisphosphonates.
hypercalaemia
Osteonecrosis of jaw
Atypical stress fractures of hip
90
What % decrease in LDL cholesterol is needed to stop change in dose?
40%
91
how do you measure response to abx?
measure CRP
92
How do you treat abx induced c difficile. which abx cause it?
metronidazole
ceftriaxone, cefotaxime, clindamycin, clarythromycin, ciprofloxacin
93
What are 3 facts about methotrexate?
teratogenic
can cause pnemonitis (rare)
narrow ther window
requires monitoring with FBC, LFT, U&E
94
How often do you start giving gentamicin? How is it different in endocarditis and renal failure?
once daily
endocarditis: 8 hourly
renal failure: 12 hourly
95
how do you measure response to abx?
measure CRP
96
Why shouldn't you give azathioprine with allopurinol?
6 mecaptopurine will build up in toxic doses
97
What are 3 facts about methotrexate?
teratogenic
can cause pnemonitis (rare)
narrow ther window
requires monitoring with FBC, LFT, U&E
98
How often do you start giving gentamicin? How is it different in endocarditis and renal failure?
once daily
endocarditis: 8 hourly
renal failure: 12 hourly
99
What does NAC replenish stores of?
glutathione which metabolises NAPQI
100
How do you reverse unfractionated heparin in overdose?
protamine sulphate
101
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) 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
First line antidepressant:
a) adult
b) child
a) sertraline
| b) fluoxetine
103
What anti epileptic should you NOT give in pregnancy and which should be used instead?
DO NOT GIVE sodium valproate
| Give lamotrigine instread
104
Name 3 SE of b blockers
```
erectile dysfunction
AKI
Bradycardia
Wheeze due to bronchospasm
Hypotension
```
105
Name 3 teratogenic medications.
```
Ace-i
Sodium valproate
Phenytoin
Isotretanoin
Trimethoprim (1st trimester only)
Methotrexate
Lithium
Carbimazole
Warfarin (1st trimester)
```
106
First line antidepressant:
a) adult
b) child
a) sertraline
| b) fluoxetine
107
what is used to treat post herpetic neuralgia?
topical lidocaine patch
108
Name 3 SE of b blockers
```
erectile dysfunction
AKI
Bradycardia
Wheeze due to bronchospasm
Hypotension
```
109
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) FFP
b) prothrombin complex (beriplex)
c) platelet transfusion
110
When addisonian patients become ill, what should be done with their steroids?
increased dose
111
what is used to treat post herpetic neuralgia?
topical lidocaine patch
112
How should you treat a patient with a CURB-65 score of:
a) <1
b) 2-3
c) >3
a) home treatment
b) hospital rx with PO/IV abx
c) ITU admission
113
What side effect can you get with B blockers that contraindicate their use in a patient with weak pulses and peripheral ulcers?
contraindicated in PAD
114
Name 3 drugs that can predispose you to vaginal thrush?
amoxicillin
clarithromycin
prednisolone
115
How do you treat acute dystonia?
procyclidine hydrochloride
116
What is white coat HTN and how is this avoided?
high BP due to anxiety of being in medical environment
| Avoided with ambulatory/home monitoring
117
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) 140/85 but 135/85 at home
| b) 150/85 and 145/85 at home
118
B blockers+thiazides used to treat HTN should be avoided in what patients?
those with/at risk of diabetes
119
In resistant HTN, name an example of an alpha blocker given.
Doxazosin
120
In a HTN crisis (BP>180/110 +organ damage) name 2 drugs that can be given IV.
sodium nitroprusside
labetalol hydrochloride
hydralazine hydrochloride
121
What medication should be given in an AF patient with a CHA2DS2-VASc score of:
a) 0
b) 1
c) 2 or more
a) aspirin 75mg daily
b) aspirin or warfarin with target INR 2.5
c) warfarin with target 2.5
122
What 4 situations is rhythm control preferred over rate control in AF?
- first presentation
- drug cause of AF
- young
- symptomatic
123
What anti-arrhythmic should not be given to patients with ischaemic/structural heart disease and what should be given instead?
do not give flecanide and DO give amiodarone
124
What is the preferred treatment of atrial flutter?
catheter ablation
125
If a LABA is inadequate in step 3 of asthma treatment, increase of steroid dose + what two other options can be considered?
leukotriene receptor antagonist (montelukast)
theopylline
126
Name 3 smoking cessation techniques.
smoking cessation clinic
nicotine replacement patch
drugs-varenicline/bupropion
127
Name 2 drug classes that cause peripheral oedema.
Ca2+ blockers
| NSAIDS
128
What is the first and second line rx for c diff infection?
1st: metronidazole PO
2nd: vancomycin PO
129
Should long acting insulin be continued when giving rx for DKA?
YES, stop short acting
130
What should be measured to monitor response to diuretics?
weight
131
Give 2 examples of drugs that can be given in severe parkinsons.
Name 2 for mild parkinsons.
co-beneldopa and co-careldopa
ropinirole and rasagiline
132
Name 3 drugs used in moderate dementia.
| Name the drug used in severe dementia.
donepezil, rivastigmine, galantamine
memantine
133
What 2 drugs can be given, alongside supportive care, to induce remission in crohn's disease?
prednisolone and hydrocortisone
134
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?
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
What 2 drugs are used to treat RA?
| What extra 2 drugs are given in a flare?
methotrexate+DMARD (sulfasalazine, hydroxychloroquine)
| In flare give: methypred IM and NSAIDS+PPI
136
If patient fails to respond to DMARDS in RA, what should be given as last resort?
TNF alpha inhibitors
| e.g. infliximab
137
what drug can be administered as antipyretic?
paracetemol
138
What 2 drugs can you give in chronic diarrhoea?
loperamide
| codeine
139
If a hypnotic is needed for insomnia, which should be given first?
zopiclone
140
Which 2 drugs cause parkinsonian symptoms?
metoclopramide
| haloperidol
141
which 2 diabetic meds can increase risk of hypoglycaemia?
insulin
| gliclazide
142
what 2 things can methotrexate and trimethoprim cause?
nephrotoxicity
| myelosupression
143
What condition causes a raised ESR to occur?
polymyalgia rheumatica
144
Name 3 SE of SSRI's
photosensitivity
suicidal ideation initially
dry mouth
145
How many weeks may go by before SSRI's become useful?
6 weeks
146
What is a diabetics target HbA1c?
<48mmol/mol
147
Name 3 drug classes that cause liver dysfunction.
NSAIDS
Diuretics
ACE-i
148
Name 5 signs of chronic liver disease.
GAPS JCS
Gynecomastic
Ascites
Peripheral oedema
Splenomegaly
Jaundice
Clubbing
Spider Naevi
149
What abx can cause hepatitis?
flucloxicillin
150
Name 5 drug causes of hepatitis that are not dose dependent (like paracetamol).
```
NSAIDS
Abx (co amox, fluclox)
TB drug (rifampicin)
methotrexate
amiodarone
```
