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Question 1

Signs lithium toxicity

Answer 1

Coarse tremor
Hyper reflexia 
Acute confusion
Seizure
Coma 

Give normal saline if mild
Can dialyse
Sodium bicarbonate to promote excretion but little evidence

Question 2

What are the kings college hospital criteria for liver transplantation in Panadol overdose?

Answer 2

Arterial pH under 7.3 24 hours post ingestion or

All of

INR over 6.5
Creat over 300
Grade 3 or 4 enceph

Question 3

How do NSAIDS affect warfarin?

Answer 3

Can displace warfarin from albumin

Question 4

Mechanism of adenosine

Answer 4

Causes transient heart block of av node

Agonist of A1 receptor which inhibits adenylyl Cyclades –> reduce cAMP –> hyper polarization by increasing outward K flux

Question 5

Aspirin mechanism

Answer 5

Inhibits production of thromboxane A2

Question 6

Clopidogrel MOA

Answer 6

Inhibits ADP binding to plt receptor

Question 7

Enoxaparin

Answer 7

Activates anti thrombin 3 which potentiates inhibition of coag factors Xa

Question 8

Flecanide MOA

Answer 8

Sodium channel blocker

–> widening of QRS, prolongation of PR interval

Question 9

What hair side effect does valproate give?

Answer 9

Alopecia

Re growth may be curly

Question 10

What does the RALES study show about spironolactone?

Answer 10

Low dose reduces all cause mortality in NYHA 3 and 4 pts already on ACE

Question 11

Which abx avoid in seizure patients?

Answer 11

Ciprofloxacin

Lowers seizure threshold

Question 12

MOA cipro?

Answer 12

Inhibits topiosomerase 2 and 4

Question 13

MOA unfractionated heparin

Answer 13

Activates anti thrombin 3

Form complex that inhibits thrombin, factors 10a, 11a, 9a, and 12a

Question 14

How does heparin and enoxaparin cause hyperkalaemia?

Answer 14

Inhibit aldosterone secretion

Question 15

Mechanism of platelet activation in hits

Answer 15

ab form complexes of platelet factor 4 and heparin - cross link FcgammaIIA receptors

Question 16

What is G6PD def?

Answer 16

RBC enzyme defects

Decrease G6PD –> reduced glutathione–> increased susceptibility to oxidative stress

Question 17

What’s on the blood film in G6PD deficiency

Answer 17

Heinz bodies

Dx via G6PD ENZME ASSAY

Question 18

What common drug should you stop when giving a macrolide?

Answer 18

Station- erythromycin inhibits the P450 ENZME that metabolises statins - increase risk of rhabdo

Question 19

Mechanism of macrolide a

Answer 19

Inhibit bacterial protein synthesis by blocking translocation

Resistant if there is post transcriptional modification of the 23s ribosomal subunit

Question 20

How do you interpret the QRS interval in TCA overdose?

Answer 20

Over 100 Ms increase seizure risk

Over 160 MS Increase ventricular arrhythmias

Question 21

What drugs precipitate lithium toxicity

Answer 21

Metronidazole
Diuretics esp thiazides
ACEi
Also renal failure, dehydration

Question 22

more likely statin myopathy if

Answer 22

lipophilic like atorva and simva

safer if hydro like rosuva, prava, fluva

Question 23

Avoid in cocaine - what med

Answer 23

beta blockers- unopposed alpha activity–>hypertensive crisis

Give BENZOS, GTN, sodium nitropr for hypertension

Question 24

can you dialyse digoxin?

Answer 24

no!

Question 25

What electrolyte disturbances worsen gent toxicity?

Answer 25

low K

low Mg

Question 26

neomycin toxicity

Answer 26

worst for the kidneys

best for the ears

Question 27

What is the nature of elimination and clearance in zero order kinetics and first order kinetics?

Answer 27

First order:
clearance constant
elimination not constant

Zero order
clearance variable
elimination constant