Therapeutics and Toxicology Flashcards

Question

what is the management of tricyclic antidepressant toxicity?

Answer 1

ABC/supportive care increased risk of seizures/arrhythmia is QRS >100ms very high risk if QRS >160ms and if R wave >3mm/abnormal QRS wave in aVR ABG - metabolic acidosis consider charcoal if significant OD <1hr before sodium bicarbonate - QRS >160ms, metabolic acidosis, arrhythmia

Answer 2

enhance activity of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) signs - sedation, ataxia, coma, respiratory depression, hypotension

Answer 3

may induce seizures and potentially fatal arrhythmias in patients who have taken mixed ads (TCAs) patients with a Hx of epilepsy patients who are benzodiazepine dependent

Answer 4

cause CNS stimulation due to release of catecholamines inhibition of uptake of catecholamines inhibition of monoamine oxidase

Answer 5

``` euphorias talkativeness anxiety (paranoia) sympathomimetic syndrome - tachycardia, hypertension, hypertonia, hyperreflexia arrhythmia - may be fatal coma convulsions haemorrhagic stroke due to hypertensive surge ```

Answer 6

hyperthermia hyponatraemia trismus/teeth grinding or other repetitive movements

Answer 7

supportive care (ABC) watch for hyperthermia cardiac, bloods and ABG monitoring agitation/repeated seizures - sedate with benzodiazepine severely unwell - risk of liver/renal failure, hyperthermia, rhabdomyolysis, arrhythmias (see critical care support)

Answer 8

IgE and histamine release e.g. anaphylaxis, atopy immediate onset

Answer 9

antibody mediated phagocytosis | e.g. ABO, compatibility

Answer 10

immune complex deposition | e.g. serum sickness

Answer 11

T. cell mediated e.g. contact dermatitis, Mantoux test onset in hours/days

Answer 12

``` beta-lactam antibiotics (penicillins and cephalosporins) contrast neuromuscular blockers anaesthetics foods insect stings ```

Answer 13

``` urticaria angiodema flushing pruritus stridor wheeze cough vomiting abdominal pain diarrhoea hypotension chest pain dysrhythmia collapse ```

Answer 14

``` ABCDE immediate intubation if impending airway obstruction remove the inciting agent IM adrenaline IV fluids IM antihistamine (chlorphenamine) IV hydrocortisone nebuliser bronchodilators refractory symptoms - IV adrenaline, vasopressors, glucagon, critical care support ```

Answer 15

mast cell tryptase only take once stable 1-2 hrs after symptoms onset repeat 24hrs later or at follow up follow up - skin prick tests, drug/food challenge, specific IgE levels if available avoidance advice optimise asthma treatment desensitisation

Answer 16

active holistic care of people with advanced, progressive illness

Answer 17

supportive - fans, pacing activities pharmacological - oramorph, benzodiazepines (sublingual lorazepam 0.5mg) oxygen if evidence of hypoxia

Answer 18

treat constipation drain ascites anti-emetics - H1 receptor antagonist (cyclizine) - inhibits emetic centre pro-kinetic (metoclopramide) - encourages peristalsis 5HT3 receptor antagonist (ondansetron) - blocks vaguely inducted vomiting, constipating effect

Answer 19

``` DVT ruptured baker's cyst cellulitis necrotising fasciitis tumour trauma haematoma arthritis (septic joint and crystal arthropathy) compartment syndrome superficial thrombophlebitis ```

Answer 20

a bacterial infection of the dermis and subcutaneous tissue usually due to a break in the skin and an inflammatory response usually caused by beta haemolytic streptococcus and staphylococcus aureus

Answer 21

swelling tenderness redness warmth over the affect area

Answer 22

pseudomonas aeruginosa - contaminated hot tubes, sponges, nail puncture erysipelothrix rhusiopathiae - butches, vets, fish handlers pasteurella multocida and capnocytophaga canimorsus - cat/dog bites eikenella corrodens - human bite, fist injuries streptobacillus moniliformis - rat bite

Answer 23

``` acute onset of red, painful, hot, swollen and tender skin spreads rapidly fever malaise nausea shivering rigours break in the skin, blisters inflamed regional lymph nodes or associated lymphangitis red, linear streaks spreading proximally ```

Answer 24

``` injury IV drug use elderly previous cancer treatment hospital stay antibiotic use obesity DM venous insufficiency oedema infection/animal bite immunosuppression skin conditions (eczema) ```

Answer 25

recurrent - damage of lymphatic drainage and chronic swelling necrotising fasciitis - infection spreads to the fascial lining septic abscess myositis worse outcome with diabetes

Answer 26

mark area of skin to assess if spreading flucloxacillin 1st line calrithromycin or clindamycin alternatives abscess - surgical drainage

Answer 27

increases the hydrostatic pressure within veins by obstruction causing oedema back pressure raises the capillary hydrostatic pressure and causes fluid to move out into tissues

Answer 28

``` calf warmth tenderness swelling erythema mild fever pitting oedema homan's sign (discomfort behind the knee on forced dorsiflexion of the foot) ```

Answer 29

``` >age trauma surgery (pelvic or orthopaedic) previous DVT/PE cancer obesity immobility thrombophilia dehydration pregnancy synthetic oestrogen ```

Answer 30

score >2 then US performed within 4hrs score <2 then D-dimer, if D-dimer is positive then US US indicated but not performed with 4hrs - interim parenteral anticoagulant dose score >2 and no DVT on US then follow up with a repeat US to confirm/exclude diagnosis

Answer 31

PE cardiac arrest post-thrombotic syndrome

Answer 32

``` LMWH 1.5mg/kg OD warfarin aim INR 2-3 NOACs usually duration 3 months cancer patients receive 6 months treatment vena cava filters percutaneous thrombectomy ```

Answer 33

stop the combined OCP 4 weeks pre-op mobilise early during admission LMWH for high risk patients after VTE assessment graduated compression stockings intermittent pneumatic compression devices

Answer 34

``` chronic leg swelling pain stiffness aches tingling cramps leg ulcers ```

Answer 35

``` lymphoedema ruptured baker's cyst, muscle, tendon, ligament, bursa haematoma superficial thrombophlebitis cellulitis ```

Answer 36

direct factor Xa inhibitor

Answer 37

direct factor IIa/thrombin inhibitor

Answer 38

direct inhibitor of activated factor X (factor Xa)

Answer 39

``` abdominal pain anaemia dyspepsia diarrhoea haemorrhage rash thrombocytopenia tachycardia angiodema ```

Answer 40

``` cellulitis superficial thrombophlebitis pelvic mass chronic venous insufficiency lymphoedema ```

Answer 41

3 factors that are important in the formation of thrombosis venous stasis vein damage activation of blood coagulation

Answer 42

1st line PUD, reflux oesophagitis (GORD) contraindications - warfarin, clopidogrel irreversibly blocks the H+/K+ ATPase proton pump ``` adverse effects - GI disturbance headaches increased risk of c diff hyponatraemia hypomagnesaemia interstitial nephritis rebound hyper secretion syndrome ```

Answer 43

2nd line for PUD, reflux oesophagitis (GORD) contraindications - inhibitor of CYP450 dependent metabolism (cimetidine>ranitidine) adverse effects - diarrhoea confusion gynaecomastia

Answer 44

anti-emetic inhibits action of dopamine in CTZ, GIT and vomiting centre metoclopramide - extrapyramidal side effects domperidone - QT prolongation (torsade de pointes)

Answer 45

gastroenteritis chemotherapy 5HT3 receptor antagonist adverse effects - QT prolongation

Answer 46

``` PPI/HR2A blocker clarithromycin amoxicillin (metronidazole if penicillin allergic) triple therapy for 7 days if complicated, continue PPI for 3 weeks ``` if due to start NSAID, should receive eradication therapy beforehand

Answer 47

generalised tonic-clonic seizures and partial seizures neuropathic pain mood stabiliser adverse effects - diplopia, ataxia, sedation, fatigue, hyponatraemia, bone marrow suppression, hypersensitivity, hepatic derangement, rash interactions - reduced effects of OCP, analgesics, anticoagulants, antivirals, steroids, statins, immunosuppressants

Answer 48

generalised tonic-clonic seizures status epilepticus protocol adverse effects - dizziness, ataxia, fatigue, diplopia, nystagmus, rash, sedation, gum hyperplasia, hirsutism, osteopenia, low folate, fever, rash, teratogenicity, lymphadenopathy

Answer 49

all type of generalised seizures ``` appetite increase, weight gain liver failure pancreatitis reversible hair loss oedema ataxia teratogenicity encephalopathy ```

Answer 50

1st choice for most seizure types safe to use in pregnancy avoid in psychiatric issues blocks synaptic vesicle release adverse effects - irritability, anxiety, fatigue, dizziness, behavioural changes, psychosis, hepatic failure

Answer 51

all types of generalised seizures mood stabilising effects safe to use in pregnancy blocks Na channels and inhibits activated Ca channels adverse effects - rash (can develop into Stevens-Johnson syndrome), insomnia interactions - OCP, other AEDs

Answer 52

generalised tonic-clonic seizures migraines neuropathic pain adverse effects - teratogenicity, appetite suppression, weight loss, psychiatric issues (avoid), word finding difficulty, renal calculi, acute angle closure glaucoma

Answer 53

5 minutes of continuous seizure activity, or briefer seizures with non-recovery of consciousness between times

Answer 54

5 mins - 4mg lorazepam (repeat once at 10-15 min, max 0.1mg/kg) 15 mins - phenytoin 20 mg/kg 15 mins - anaesthetic drugs in ICU with EEG monitoring (propofol, midazolam, thiopentone)

Answer 55

lifestyle measures mono therapy - metformin sulfonylurea - if the patient is not overweight, metformin not tolerated/contraindicated, rapid therapeutic response required if HbA1c >48mmol/mol on maximum dose mono therapy, add second drug

Answer 56

biguanide reduces hepatic glucose output increases glucose uptake adverse reactions - nausea, vomiting, use with caution in sudden renal deterioration

Answer 57

T2DM management in those with no ketosis and no response to weight control and dietary therapy stimulate the release of insulin from beta cells adverse effects - hypoglycaemia (when used with alcohol, beta blockers, MAOI), weight gain, allergic reactions, pruritus, rash, hepatotoxicity, photosensitivity, hyponatraemia, water retention

Answer 58

step 3/4 stop after 6 months if HbA1c has not dropped by 0.5% decrease insulin resistance and increase glucose uptake in skeletal muscle adverse effects - hepatotoxicity, weight gain, hypos, increased risk of bladder cancer, HF, CVD risk, fracture risk

Answer 59

targeted at those who are overweight sc injections mimics the action of GLP1 adverse effects - GI disturbance, dizziness, dyspepsia, injection site reactions, pancreatitis risk, caution in renal disease, gastroparesis

Answer 60

2nd line after metformin/sulfonylureas inhibits the breakdown of incretins-GLP 1 increases insulin and decreased glucagon adverse effects - nasopharyngitis, URTI, headache, peripheral oedema, nausea, weight neutral/small weight gain, HF risk in the presence of heart or renal disease

Answer 61

add-on therapy to metformin and other glucose lowering drugs block reabsorption in PCT preventing glucose reabsorption doesn't depend on insulin sensitivity adverse effects - reduced effectiveness in renal impairment contraindicated in surgery and pregnancy polyuria increased UTIs ketoacidosis increased risk of AKI (especially in HF, diuretics, ACEis) and osteoporosis

Answer 62

concomitant oral opioids; dihydrocodeine

Answer 63

``` erectile dysfunction dehydration postural hypotension hyponatraemia hypokalaemia hypercalcaemia gout impaired glucose tolerance impotence thrombocytopenia photosensitive rash agranulocytosis pancreatitis ```

Answer 64

diarrhoea nausea abdominal pain hypoglycaemia

Answer 65

``` nausea vomiting constipation B12 deficiency lactic acidosis ```

Answer 66

``` diarrhoea nausea vomiting hyponatraemia hypomagnesaemia ```