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Year 5 Core Conditions > PSA revision > Flashcards

PSA revision Flashcards

1
Q

What are the enzyme inducers?

A

PC BRAS:

  • Phenytoin
  • Carbamazepine
  • Barbiturates
  • Rifampicin
  • Alcohol (chronic excess)
  • Sulphonylureas
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2
Q

What does it mean by enzyme inducers - what happens to the concentration of the drug?

A

They increase the activity of enzymes and thus decrease the drug concentrations

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3
Q

What does it mean by enzyme inhibitors?

A

They decrease enzyme activity and thus increase drug concentrations

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4
Q

What are the enzyme inhibitors?

A

AODEVICES

  • Allopurinol
  • Omeprazole
  • Disulfiram
  • Erythromycin
  • Valproate
  • Isoniazid
  • Ciprofloxacin
  • Ethanol
  • Sulphonamides
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5
Q

What are the drugs that should be stopped before surgery?

A

I LACK OP

  • Insulin
  • Lithium
  • Anticoagulants/antiplatelets
  • COCP/HRT
  • K-sparing diuretics
  • Oral hypoglycaemics
  • Perindopril (and other ACEi)
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6
Q

How long before surgery should COCP/HRT be stopped?

A

4 weeks

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7
Q

What are the side effects of steroid use?

A

STEROIDS

  • Stomach ulcers
  • Thin skin
  • oEdema
  • Right and left heart failure
  • Osteoporosis
  • Infection
  • Diabetes
  • Syndrome Cushing’s
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8
Q

What is the fastest rate that IV potassium can be given?

A

10mmol/hour

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9
Q

Why should cyclizine be avoided in patients with cardiac problems?

A

It can worsen fluid retention

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10
Q

What are the first line medications for neuropathic pain?

A
  • Amitriptyline 10mg PO nightly
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11
Q

Which drug is known to cause hyperkalaemia and why?

A

ACE inhibitors e.g. ramipril or lisinopril - through reduced aldosterone production and thus reduced potassium excretion in the kidneys.

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12
Q

Why do ACE inhibitors cause a dry cough?

A

They lead to a production of bradykinin via reduced degradation of ACE

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13
Q

Why are you at risk of stomach uclers when taking ibuprofen?

A

Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection from acid.

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14
Q

Why can ibuprofen also contribute to renal failure?

A

The inhibition of prostaglandin synthesis also reduces renal artery diameter and blood flow thereby reducing kidney perfusion and function

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15
Q

Why is ibuprofen a bad choice for asthmatics?

A

It can cause bronchoconstriction

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16
Q

If a patient is on methotrexate and has a UTI, which antibiotic should be avoided, and why?

A

Trimethoprim - as it is a folate antagonist and because methotrexate is as well, can cause bone marrow toxicity

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17
Q

What is a side effect of calcium channel blockers, and the reason they should not be started in someone with heart failure?

A

They can lead to peripheral oedema

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18
Q

If someone on warfarin is found to have an INR of between 5-8, but no bleeding, what is the guideline for management?

A

Stop warfarin for 1-2 days and reduce maintenance dose

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19
Q

If someone on warfarin is found to have an INR of greater than 8, but no active bleeding, what is the management?

A

Stop warfarin until INR is <5, and give oral phytomenadione 5 mg (aka vitamin K)

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20
Q

What are the two principal abnormalities to gain from assessing U&Es?

A

If there is an electrolyte disturbance and the performance of the kidneys based upon creatinine and urea

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21
Q

In basic terms, if there are high neutrophils, what type of infection does this indicate?

A

A bacterial infection

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22
Q

If neutrophils are low, or lymphocytes are raised, what type of infection can this classically indicate?

A

A viral infection

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23
Q

Which drugs can cause neutropenia?

A

Clozapine and carbimazole

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24
Q

What are the causes of SIADH?

A

SIADH

  • Small cell lung tumours
  • Infection
  • Abscess
  • Drugs (especially carbamazepine and antipsychotics)
  • Head injury
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25
Q

The mnemonic DIRE can be used to remember the causes of hypokalaemia. What does it refer to?

A

DIRE

  • Drugs - loop and thiazide diuretics
  • Inadequate intake or intestinal loss e.g. diarrhoea/vomiting
  • Renal tubular acidosis
  • Endocrine (Cushing’s and Conn’s syndromes)
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26
Q

The mnemonic DREAD can be used to remember the causes of hyperkalaemia, what does it refer to?

A

DREAD

  • Drugs - potassium-sparing diuretics and ACEi
  • Renal failure
  • Endocrine (Addison’s disease)
  • Artefact (very common, due to clotted sample)
  • DKA
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27
Q

A raised urea can indicate kidney injury, but what else can it indicate, especially in someone with a normal creatinine?

A

An upper GI bleed

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28
Q

What are the pre-renal causes of AKI - accounting for 70% of AKIs?

A
  1. Dehydration of any cause e.g. sepsis, shock, blood loss

2. Renal artery stenosis

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29
Q

What are the two types of toxicity caused by gentamicin and vancomycin?

A

Ototoxicity and nephrotoxicity

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30
Q

In patients with Addison’s disease, if they develop an infection, which drug is important to increase the dose to provide adequate response to the increased stress?

A

Corticosteroids e.g. hydrocortisone

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31
Q

For the treatment of epilepsy, the type of seizure determines the drug choice. What is the first choice for a generalised tonic-clonic seizure?

A

Sodium valproate

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32
Q

What is first line for absence seizures?

A

Sodium valproate or ethosuximide

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33
Q

What is first line for focal seizures?

A

Carbamazepine or lamotrigine

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34
Q

What are the side effects of sodium valproate? (3 T’s)

A

Tremor
Teratogenicity
Tubby - weight gain

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35
Q

What is the usual treatment for someone with mild Alzheimer’s?

A

AChE inhibitors - acetylcholinesterase inhibitors

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36
Q

What are the three licensed drugs for Alzheimers? (3)

A
  1. Donepezil
  2. Rivastigmine
  3. Galantamine
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37
Q

For the treatment of Crohn’s disease. what is used to induce remission?

A

Steroids - prednisolone or if a severe flare up then hydrocortisone

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38
Q

What is the treatment for maintaining remission in Crohn’s disease?

A

Azathioprine or 6-mercaptopurine

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39
Q

What is the usual treatment for rheumatoid arthritis?

A

Methotrexate and a DMARD e.g. sulfasalazine or hydroxychloroquine

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40
Q

If rheumatoid arthritis fails to respond to the usual drugs and two DMARDs have been tried, what can be tried?

A

Infliximab or TNF-alpha inhibitor

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41
Q

Which laxative is good for faecal impaction?

A

A stool softener e.g. sodium docusate

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42
Q

Which laxative is a stimulant?

A

Senna

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43
Q

Which laxative is osmotic?

A

Lactulose

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44
Q

If a woman being treated with ACEi for hypertension wishes to conceive, which drug should she be switched to?

A

Labetalol

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45
Q

Why are weekly blood tests required when a patient takes methotrexate?

A

They are at risk of neutropenia

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46
Q

What can long-term steroid use increase the risk of?

A
  1. Diabetes
  2. Gastric ulcers
  3. Hypertension
  4. Addisonian crisis if stopped suddenly
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47
Q

What should potentially be given to patients alongside long-term steroid therapy who are older?

A

Bisphosphonates to prevent osteoporosis

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48
Q

What advice is important to give to someone starting on bisphosphonates?

A

The tablets should be swallowed with a full glass of water and the patient should remain upright for 30 minutes afterwards to prevent gastric side effects. Additionally the drug is taken once weekly and food needs to be avoided for up to two hours after taking the tablet as it reduces its absorption.

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49
Q

In someone with Factor V Leiden, experiencing a DVT and haemoptysis. What would be the first line treatment?

A

A LMWH - e.g. daltaparin at a treatment dose e.g. 15000 units S/C

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50
Q

What is the appropriate first line treatment for chronic heart failure in someone who has asthma?

A

An ACE inhibitor e.g. ramipril

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51
Q

What is the first line rate control treatment for someone with AF, who has asthma?

A

Calcium channel blocker - verapamil

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52
Q

When is metformin not a first line medication for patients with type 2 diabetes that is not controlled through diet and exercise?

A

If the patient is not overweight or if their creatinine is >150umol/L. If their creatinine is above this threshold, they are at risk of lactic acidosis.

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53
Q

When starting someone on a statin, what is important to test beforehand, and why?

A

LFTs - the liver metabolises statins and if AST/ALTs are raised more than 3 times the normal, they increase the risk of myopathy, as the liver impairment will increase the levels of statins as they won’t be metabolised. Consequently the LFTs need to be checked before, at 3 months and at 12 months after commencing the treatment.

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54
Q

For the commencement of lithium medication, when is the sampling time recommended to check levels, after how long?

A

12 hours after the last dose

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55
Q

At what level for serum lithium concentrations is judged to be toxic?

A

> 1.5mmol/L

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56
Q

Olanzapine can cause what side effect in patients, which requires a baseline test for what?

A

Can cause hyperglycaemia and diabetes, and therefore a fasting blood glucose must be tested at baseline and regular intervals thereafter

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57
Q

Why does a baseline CXR need to be carried out before starting someone on amiodarone?

A

As there is a risk of pulmonary toxicity

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58
Q

When someone is on a multiple daily dose regimen of gentamicin for endocarditis, what range should their serum concentration be?

A

3-5mg/l

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59
Q

Why is it important to monitor U&Es when someone is taking ACE inhibitors?

A

As they can cause hyperkalaemia, hyponatraemia and AKI

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60
Q

Why is it useful to monitor serum creatinine in someone taking digoxin?

A

As digoxin is excreted renally, so if there is renal impairment then there is an increased risk of toxicity

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61
Q

When someone is started on sodium valproate, what blood test is important to check first?

A

LFTs - valproate is associated with hepatoxicity and liver function should be measured at baseline as well as at regular intervals through the duration of therapy

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62
Q

What vitamin supplementation is usually required when someone is starting on valproate and why?

A

Vitamin D supplementation due to the risk of osteoporosis

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63
Q

If someone is started on clozapine, for how many weeks should they have weekly FBCs and why?

A

18 weeks, due to the risk of neutropenia and potentially fatal agranulocytosis

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64
Q

What are the side effects associated with ACE inhibitors?(4)

A
  1. Hypotension
  2. Electrolyte abnormalities (raised potassium)
  3. AKI (but can help chronic renal failure)
  4. Dry cough
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65
Q

What are the side effects associated with beta blockers? (4)

A
  1. Hypotension
  2. Bradycardia
  3. Wheeze in asthmatics
  4. Worsens acute heart failure (but helps chronic heart failure)
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66
Q

What are the adverse drug reactions associated with calcium channel blockers? (4)

A
  1. Hypotension
  2. Bradycardia
  3. Peripheral oedema
  4. Flushing
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67
Q

What are the adverse drug reactions associated with diuretics e.g. furosemide, bendoflumethiazide and spironolactone? (3)

A
  1. Hypotension
  2. Electrolyte abnormalities
  3. AKI
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68
Q

What are the adverse reactions associated with heparins? (2)

A
  1. Haemorrhage (especially if renal failure or <50kg)

2. Heparin-induced thrombocytopenia

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69
Q

What are the adverse drug reactions associated with warfarin?

A

Haemorrhage (ironically warfarin has a pro-coagulant effect initially as well as taking a few days to become an anti-coagulant, thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2)

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70
Q

What are the adverse drug reactions associated with aspirin? (4)

A
  1. Haemorrhage
  2. Peptic ulcers
  3. Gastritis
  4. Tinnitus (in large doses)
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71
Q

What are the adverse drug reactions associated with digoxin? (6)

A
  1. Nausea
  2. Vomiting
  3. Diarrhoea
  4. Blurred vision
  5. Confusion and drowsiness
  6. Xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)
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72
Q

What are the adverse reactions associated with amiodarone? (4)

A
  1. Interstitial lung disease (pulmonary fibrosis)
  2. Thyroid disease (due to its structural relation to iodine)
  3. Skin greying
  4. Corneal deposits
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73
Q

What are the early, intermediate and late side effects off lithium use?

A

Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, diabetes

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74
Q

What are the side effects associated with haloperidol?

A

Dyskinesias e.g. acute dystonic reactions, drowsiness

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75
Q

What is the side effect associated with clozapine?

A

Agranulocytosis

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76
Q

What is amiloride?

A

A potassium sparing diuretic, known to cause hyperkalaemia.

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77
Q

How does metformin work compared to sulphonylureas?

A

Metformin is a biguanide. It acts by limiting hepatic gluconeogenesis (creation of new sugar by the liver). Lactate is usually taken up in the process and without new sugar production in the liver it can build up leading to lactic acidosis. Sulphonylureas act by chemically squeezing insulin out of the pancreas.

78
Q

Which drugs can significantly reduced lithium excretion and hence possibly lead to lithium toxicity? (3)

A
  1. ACE inhibitors
  2. Diuretics
  3. NSAIDs
79
Q

If a diuretic must be given to someone taking lithium, which one is the safest to use?

A

Furosemide (loop diuretics)

80
Q

What is a ‘polyuric phase’?

A

When a patient is recovering from renal failure and their urine output increases (which looks to be a good sign) but fluid input does not keep up, resulting in dehydration and electrolyte abnormalities. Urine output exceeding 200ml/h should always prompt consideration of this phenomenon.

81
Q

What is the mnemonic used to remember the causes of hyperkalaemia?

A 
DREAD
D - drugs 
R - renal failure
E - endocrine - addisons
A - artefact
D - DKA
82
Q

When is metformin not a first line drug for type 2 diabetes?

A

In someone with CKD and an eGFR <30ml and used in caution if <45ml/minute.
A sulphonylurea may also be considered if the patient is normal or underweight as metformin can suppress appetite

83
Q

What are the drugs that can cause SIADH? (5)

A
  1. Sulphonylureas
  2. SSRIs, tricyclics
  3. Carbamazepine
  4. Vincristine
  5. Cyclophosphamide
84
Q

If a patient with AF and asthma is started on digoxin, what needs to be monitored?

A

Serum digoxin levels 6 hours after dose, and a ventricular rate at rest

85
Q

Why should aspirin be avoided in woman who are breastfeeding?

A

Due to the risk of Reyes syndrome

86
Q

What % of patients who are allergic to penicillin are also allergic to cephalosporins?

A

0.5-6.5%

87
Q

Which antibiotic groups are known to be harmful in pregnancy?

A
  1. Tetracyclines
  2. Aminoglycosides
  3. Sulphonamides and trimethoprim
  4. Quinolones
88
Q

Name some macrolides? (3)

A
  1. Erythromycin
  2. Azithromycin
  3. Clarithromycin
89
Q

Name some cephalosporins? (4)

A
  1. Cefaclor
  2. Cefalexin
  3. Ceftriaxone
  4. Cefotaxime
90
Q

In addition to some antibiotics, which other drugs are not safe during pregnancy? (6)

A
  1. ACE inhibitors, ARBs
  2. Statins
  3. Warfarin
  4. Sulphonylureas
  5. Retinoids (including topical)
  6. Cytotoxic agents
91
Q

Which antibiotics are safe to use while breastfeeding? (3)

A
  1. Penicillins
  2. Cephalosporins
  3. Trimethoprim
92
Q

Which antihistamine is given during anaphylaxis?

A

Clorphenamine

93
Q

Gliclazides can cause patients to gain or lose weight?

A

Gain weight

94
Q

Which group of antibiotics should be avoided in people with epilepsy and why?

A

Fluoroquinolones - known to rigger siezures or lower seizure thresholds

95
Q

Which statin and what dose is first line for patients with established cardiovascular disease?

A

Atorvastatin 80mg

96
Q

If the statin is being prescribed for primary prevention, which one and what dose is first line?

A

Atorvastatin 20mg

97
Q

Which medications are known to exacerbate heart failure? (4)

A
  1. Thiazolidinendiones (pioglitazone is contraindicated as it causes fluid retention)
  2. Verapamil
  3. NSAIDs/glucocorticoids
  4. Class I antiarrhythmias - flecainide
98
Q

Which blood tests are required as a baseline before starting quetiapine for psychosis? (8)

A
  1. FBC
  2. U&Es
  3. LFTs
  4. Fasting blood glucose
  5. Fasting lipids
  6. Weight
  7. Blood pressure
  8. Prolactin
99
Q

What are the indications/clinical uses of bisphosphonates? (4)

A
  1. Prevention and treatment of osteoporosis
  2. Hypercalcaemia
  3. Paget’s disease
  4. Pain from bone metastases
100
Q

What are the adverse reactions caused by bisphosphonates?

A
  1. Oesophageal reactions: oesophagitis, oesophageal ulcers
  2. Osteonecrosis of the jaw
  3. Risk of atypical stress fractures of the proximal femoral shaft
  4. Acute phase response: fever, myalgia, arthralgia
  5. Hypocalcaemia
101
Q

What is the advice regarding taking bisphosphonates?

A

Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast. Patient should sit or stand upright for at least 30 minutes after taking tablet.

102
Q

What is the recommended treatment for pulmonary oedema?

A

Furosemide 25-50mg IV once only (IM could be considered too)

103
Q

What is the first line treatment for someone with hypoglycaemia and a GCS on 10/15?

A

20% glucose 50ml over 15 minutes. This would provided 10-20grams carbohydrate quickly. (If no venous access then IM glucagon)

104
Q

What is the BNF guidance surrounding INR before surgery for patients normally taking warfarin?

A

If the INR is >1.5, then phytomenadione (vitamin K) needs to be given - 1 -5mg PO

105
Q

When treating the pulmonary oedema with furosemide, what is the best indicator for how successful the treatment is?

A

The patients weight

106
Q

What are the most serious side effects associated with cyclosporine?

A

Nephrotoxicity and hypertension which are thought to be mediated by vasoconstrictive effects on renal arterioles. Before initiation of treatment, a baseline assessment of renal function should be established and it is recommended that renal function is monitored every 2 weeks until results are stable. Blood pressure should also be monitored on a regular basis.

107
Q

Which drug is first line for treating acute oculogyric/dystonic crisis as an adverse effect of neuroleptic medication?

A

Procyclidine hydrochloride

108
Q

When is chemical cardioversion not indicated for someone presenting with new onset AF?

A

In patients who are older and who are presenting later than 48 hours from onset - due to the risk of thromboembolism. Additionally if there are structural heart defects then flecainide is contraindicated.

109
Q

What is important to monitor when being treated with digoxin?

A

U&Es due to digoxin being renally excreted. Patients with renal dysfunction are more at risk of toxicity.

110
Q

What needs to be checked before starting someone on valproate? (aside from pregnancy stuff)

A

Liver function needs to be tested as a baseline as it is associated with hepatotoxicity

111
Q

When is enoxaparin dose adjusted? (2)

A
  1. Adults <50kg

2. eGFR <30mL/min

112
Q

Hepatic encephalopathy - look this up

A

Lactulose

113
Q

Why is simvastatin contraindicated in pregnancy?

A

Congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development

114
Q

When taking a statin, what needs to be monitored at baseline, 3 months and 12 months?

A

LFTs

115
Q

What blood tests need to be monitored 6 monthly for patients on amiodarone?

A

LFT and TFT

116
Q

What blood tests need to be monitored 3 monthly for people on azathioprine?

A

FBC and LFTs

117
Q

For people taking lithium, which blood tests need to be monitored 6 monthly? (as well as before treatment and weekly when stabilising dose)

A

TFTs and U&Es

118
Q

Which two cardiovascular drugs should never be prescribed together due to the risk of life-threatening bradycardias?

A

Beta-blockers and verapamil

119
Q

Which drugs should be used with caution in patients with asthma? (3)

A
  1. NSAIDs
  2. Beta blockers
  3. Adenosine
120
Q

Which drugs are known to exacerbate psoriasis? (6)

A
  1. Beta blockers
  2. Lithium
  3. Antimalarials
  4. NSAIDs
  5. ACE inhibitors
  6. Infliximab
121
Q

Which drug, sometimes used in the treatment of AF, is contraindicated in people with structural heart disease?

A

Flecainide

122
Q

Which drugs are known to worsen seizure control in patients with epilepsy? (6)

A
  1. Alcohol, cocaine and amphetamines
  2. Ciprofloxacin, levofloxacin
  3. Aminophylline, theophylline
  4. Bupropion
  5. Methylphenidate
  6. Mefenamic acid
123
Q

In someone on gentamicin TDS IV, if the trough levels are raised, how should their regime be managed?

A

Change it to BD, as opposed to lowering the dosage

124
Q

Which drug is known to reduce the awareness of hypoglycaemia in diabetes patients?

A

Beta-blockers - as the symptoms are often anxiety, sweating, tachycardia and BBs can reduce this

125
Q

What is the preferred steroid for mild/moderate croup and why?

A

Dexamethasone is first line as it has less mineralcorticoid activity than prednisolone.

126
Q

Which drugs are known to cause SIADH?

A
  1. Sulfonylureas
  2. SSRIs, tricyclics
  3. Carbamazepine
  4. Vincristine
  5. Cyclophosphamide
127
Q

If a woman is started on tamoxifen what information is important to relay?

A
  1. High risk of experiencing hot flushes

2. Increased risk of thromboembolism - be cautious of swelling in calves

128
Q

When should people taking steroids withdraw gradually from the drug, rather than stopping it abruptly?

A

The BNF suggests gradual withdrawal of systemic corticosteroids if patients have:
received more than 40mg prednisolone daily for more than one week
received more than 3 weeks treatment
recently received repeated courses

129
Q

What is the optimal anti-emetic choice for a patient with cardiac problems and electrolyte disturbances?

A

Cyclizine 50mg - check if the Q mentions QTc interval

130
Q

What is the treatment of choice for shingles?

A
  1. Aciclovir (800MG PO 5 times daily for 7 days)
  2. Famciclovir
  3. Valaciclovir
131
Q

Ciclosporin and eplerenone are both known to cause what side effect?

A

Hyperkalaemia

132
Q

What is the maximum daily dose of citalopram for elderly patients?

A

20mg

133
Q

Alendronic acid and lansoprazole can both cause what side effect?

A

Loose stools/diarrhoea

134
Q

Alendronic acid and prednisolone can both cause what GI problems?

A

Dyspepsia - alendrotnic acid is a direct irritant to the upper GI tract and symptoms are not improved by PPIs

135
Q

Digoxin and beta blockers both cause what common effect?

A

Bradycardia

136
Q

Amlodipine and naproxen both cause what side effect?

A

Ankle swelling

137
Q

What is the difference in therapy for vulvovaginal candidiasis for a pregnant woman compared to not pregnant?

A

The therapy needs to be prolonged in therapy - normally it is just given as a single dose applicator, but in pregnancy it is clotrimazole pessary 100mg PV daily for 7 days (systemic therapy is not recommended in pregnancy)

138
Q

Which antibiotic is indicated for repeated C.diff infections?

A

Vancomycin

139
Q

What needs to be monitored regularly during ciclosporin use?

A

Kidney function - serum creatinine should be monitored every 2 weeks for the first 3 months, then monthly

140
Q

When is the ophthalmic solution of cyclosporine used?

A

To help tear production in patients suffering from keratoconjunctivitis sicca

141
Q

Liraglutide causes what common side effect?

A

Vomiting - GLP1 analogue frequently causes initial GI upset including nausea and vomiting

142
Q

Which drug is known to precipitate serotonin syndrome?

A

Tramadol

143
Q

What needs to be monitored when someone is started on the COCP after a month?

A

Blood pressure

144
Q

What needs to be monitored before azathioprine is started?

A

Thiopurine methyltransferase (TPMT)

145
Q

If someone on long-term morphine has AKI, what can their morphine sulphate be switched to if they are acute pain?

A

Substitute the morphine sulphate for oxycodone - it is metabolised by the liver to inactive metabolites, making it appropriate where strong analgesia is required in the setting on renal impairment

146
Q

What is the treatment for warfarin reversal in severe bleeding and INR 10 (in addition to vitamin K)?

A

Dried prothrombin complex 50 units/kg IV once only

147
Q

What should happen to the dose of amiodarone if a patient develops thyrotoxicosis?

A

Withhold the amiodarone

148
Q

Which drugs can cause urinary retention? (particularly in the older population) (6)

A
  1. Morphine/opiates
  2. General anaesthetics
  3. Benzodiazepines
  4. NSAIDs
  5. CCBs
  6. Antihistamines
149
Q

The INR of a patient who has recently started treatment for TB drops from 2.6 to 1.3. Which medication is most likely to be responsible?

A

Rifampicin - it is an P450 inducer and will therefore increase the metabolism of warfarin, therefore decreasing the INR.

150
Q

If the INR of a patient on warfarin went from 2.6 to 6.5, and was recently started on treatment for TB. Which drug most likely caused it to happen?

A

Isoniazid - it is an enzyme inhibitor therefore decreasing the metabolism of warfarin

151
Q

Which NSAID is contraindicated with any form of cardiovascular disease?

A

Diclofenac

152
Q

What is digoxin’s mechanism of action?

A

It inhibits the sodium/potassium pump

153
Q

How does serotonin syndrome present?

A
  1. Altered mental state
  2. Hyperthermia
  3. Hyperreflexia
  4. Pupil dilation
154
Q

Which drugs can lead to serotonin syndrome? (3)

A
  1. SSRIs (and other antidepressants)
  2. Ecstasy overdose
  3. Amphetamine overdose
155
Q

When should the antimalarial; mefloquine not be prescribed?

A

If there is a history of depression and/or anxiety

156
Q

What are the side effects of ciclosporin? (8)

A

Everything is increased:

  1. Hypertension
  2. Hyperkalaemia
  3. Gingival hyperplasia
  4. Tremor
  5. Hyperlipidaemia
  6. Excessive hair growth
  7. Nephrotoxicity
  8. Hepatotoxicity
157
Q

What is the classic side effects associated with pioglitazone? (4)

A
  1. Increased risk of fractures
  2. Weight gain
  3. Fluid retention
  4. Liver dysfunction
158
Q

Which drugs can caused drug-induced lupus? (2)

A
  1. Procainamide (antiarrhythmia)

2. Hydralazine

159
Q

What 4 side effects can verapamil cause? (3 of which all CCBs cause)

A
  1. Headache
  2. Flushing
  3. Ankle oedema
  4. Constipation (only V)
160
Q

What are the four side effects associated with beta blockers?

A
  1. Bronchospasm
  2. Fatigue
  3. Cold peripheries
  4. Sleep disturbances
161
Q

What are the side effects associated with nitrates? (3)

A
  1. Headache
  2. Postural hypotension
  3. Tachycardia
162
Q

What are the side effects associated with nicorandil? (3)

A
  1. Head ache
  2. Flushing
  3. Anal ulceration …ouch
163
Q

Which cardiac problem can lithium use in pregnancy cause to the unborn baby?

A

Ebstein’s anomaly

164
Q

Which TB drug is known to cause optic neuritis?

A

Ethambutol

165
Q

What are the adverse affects associated with 5 alpha-reductase inhibitors e.g. finasteride? (4)

A
  1. Impotence
  2. Decreased libido
  3. Ejaculation disorders
  4. Gynaecomastia and breast tenderness
166
Q

Which drug is used to reserve large doses of IV heparin used during cardiac bypass surgery?

A

Protamine sulphate

167
Q

Which drugs exhibit zero-order kinetics? (4)

A
  1. Phenytoin
  2. Salicylates (e.g. high-dose aspirin)
  3. Heparin
  4. Ethanol
168
Q

Why does heparin-induced thrombocytopenia occur?

A

It is immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin. Usually develops 5-10 days after start of treatment and it is classed as a pro-thrombotic condition.

169
Q

What is the single most important factor for deciding if someone needs a liver transplant after paracetamol overdose? (i.e. which test needs to be most deranged)

A

If arterial pH is <7.3, 24 hours after digestion

or 
all of the following:
1. Prothrombin time >100 seconds
2. Creatiine >300umol/l
3. Grade III or IV encephalopathy
170
Q

Why must metformin be stopped following a myocardial infarction (acutely not long-term wise)?

A

Due to the risk of lactic acidosis

171
Q

What may be seen on ECG of someone with a tricyclic overdose?

A

QRS widening

172
Q

Which drugs should be avoided in renal failure? (5)

A
  1. Tetracycline
  2. Nitrofurantoin
  3. NSAIDs
  4. Lithium
  5. Metformin
173
Q

In someone with lithium toxicity presenting with seizures, after IV fluid, what is the next treatment step?

A

Haemodialysis

174
Q

What is the antidote to tricyclic antidepressants e.g. amitriptyline overdose?

A

IV bicarbonate

175
Q

Which antibiotic is known to lower the seizure threshold?

A

Ciprofloxacin

176
Q

Which electrolyte abnormality predispose patients to digoxin toxicity?

A

Hypokalaemia

177
Q

What do serotonin agonists treat?

A

Triptans - acute migraine

178
Q

What do serotonin antagonists work ask?

A

Anti-emetics e.g. ondansetron

179
Q

What kind of drug is required to work as a depolarising muscle relaxant used for rapid sequence induction?

A

Nicotinic agonist e.g. atracurium

180
Q

When should allopurinol be started when someone presents with an acute attack of gout?

A

2 weeks after - as it increases the risk of gout in the long term

181
Q

Which two drug groups are the most common causes of urinary retention?

A

Opioids and anticholinergics

182
Q

Which form of morphine is safest to use for someone with renal failure but suffering acute pain?

A

Oxycodone (it is mainly metabolised by the liver)

183
Q

What is the main mechanism of action of ondansetron?

A

5-HT3 receptor antagonist

184
Q

What is a rare side effect of sitagliptin?

A

Pancreatitis

185
Q

What is an early symptom of aspirin overdose?

A

Tinnitus

186
Q

What type of drug is given to a woman admitted with psychotic delusions? (the mechanism of action of the group of drugs)

A

Dopamine antagonist

187
Q

What type of drug is flumazenil?

A

GABA antagonist

188
Q

What is the first-line treatment for someone with digoxin toxicity/overdose?

A

Administered digoxin-specific antibody fab fragments IV aka Digibind

189
Q

What can metformin cause in patients with an impaired renal function?

A

Lactic acidosis

190
Q

Which two diuretics should never be prescribed in concomitantly?

A

Amiloride and spironolactone - because they are both potassium sparing diuretics so puts the patient at high risk of hyperkalaemia

191
Q

Which of the anti-TB dugs is known to cause peripheral neuropathy?

A

Isoniazid

Year 5 Core Conditions (25 decks)

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