Pharmacology

Question 1

SE common epileptic drugs

Answer 1

Sodium valproate: teratogenic, hair loss, liver damage, tremor

Carbamazepine: agranulocytosis, aplastic anaemia, induces P450

Phenytoin: folate and vit D deficiency

Lamotrigine: Stevens johnson syndrome, leukopenia

Question 2

SE PD drugs

Answer 2

Levodopa: dystonia, chorea, athetosis

Dopamine agonists e.g. cabergoline: pulmonary fibrosis

Question 3

Summarise metformin (SE, CI)

Answer 3

Metformin:
first line, decreases gluconeogenesis, increases peripheral uptake of glucose, only works if insulin still semi-functioning.
CI: eGFR <30 due to ketoacidosis, DKA, acute metabolic acidosis
SE: diarrhoea, lactic acidosis
If complain diarrhoea move them to modified release rather than standard release
Fine in pregnancy BUT NO OTHERS ARE OKAY IN PREGNANCY!!!!!!!!!
Next line: DPP-4 inhibitor -> pioglitazone -> sulfonylureas (gliclazide) -> SGLT-2 inhibitors (gliflozins)

Question 4

Summarise DPP-4 Inhibitors

Answer 4

DPP-4 inhibitor (gliptins):
Inhibits the enzyme that Breaks down incretins (GLP1/2), → incretins lower blood glucose by stimulating  insulin release from the pancreas 
CI: DKA
SE: wt loss, pancreatitis
Linagliptin good in renal dysfunction

Question 5

Summarise Pioglitazone

Answer 5

Increase insulin sensitivity, promote fatty acid uptake and storage, reduce BP
CI: HF (water retention), bladder cancer - report any painless haematuria
SE: weight gain (increased fatty acid uptake), OP

Question 6

Summarise Sulfonylureas

Answer 6

Sulfonylureas (gliclazide)
Increase insulin release - so need some residual function
CI: G6PD deficiency, DKA, hepatic impairment
SE: hypoglycaemia, wt gain, CVD and MIs
Long acting (glibenclamide) DONT give in elderly

Question 7

Summarise SGLT-2 Inhibitors

Answer 7

SGLT-2 inhibitors (gliflozins)
Sodium-glucose co-transporter inhibitor→ increases sodium and glucose out as stops reabsorption of these in the kidneys.
CI: eGFR <60 - need pretty good kidney function as works primarily on the kidneys, DKA
SE: wt loss, UTI/ thrush as losing lots of sugar in urine, fournier’s gangrene, euglycemic DKA

Question 8

Summarise GLP-1 agaonists

Answer 8

GLP-1 agonists (Exenatide, liraglutide, dulaglutide)
Give once weekly sc
Mimic incretins
CI: renal disease, gastroparesis, DKA
SE: pancreatitis, wt loss
Only keep someone on these if is reducing hba1c and wt

Question 9

Key SE of quinolones

Answer 9

e.g. ciprofloxacin

Achilles tendon rupture
Lower seizure threshold

Question 10

What are the general rules for antibiotic coverage?

Answer 10

Amoxicillin covers strep, listeria and enteroccocus —> + Co-amox covers staph, haemophilus and e.coli —-> + tazocin covers pseudomonas –> + meropenem so cover ESBL —> adding teicoplanin/ vancomycin covers MRSA —> Adding Doxycycline/ clarithromycin covers atyicals

Question 11

What are examples of macrolides?

Answer 11

erythromycin, clarithromycin and azithromycin

Question 12

What are examples of tetracyclines?

Answer 12

doxycycline

Question 13

What are examples of quinolones?

Answer 13

Ciprofloxacin, ofloxacin , levofloxacin

Question 14

What are examples of cephalosoprins?

Answer 14

ceftriaxone, cefadroxil and cefalexin

Question 15

What are examples of Aminoglycosides

Answer 15

gentamicin and tobramycin.

Question 16

WHat medications cause sensironeural HL?

Answer 16

Loop diuretics (e.g., furosemide)
Aminoglycoside antibiotics (e.g., gentamicin)
Chemotherapy drugs (e.g., cisplatin)

Question 17

SE of methotrexate

Answer 17

Mouth ulcers and mucositis
Liver toxicity
Pulmonary fibrosis
Bone marrow suppression and leukopenia (low white blood cells)
It is teratogenic (harmful to pregnancy) and needs to be avoided prior to conception in mothers and fathers

Question 18

SE of leflunomide

Answer 18

Mouth ulcers and mucositis
Increased blood pressure
Rashes
Peripheral neuropathy
Liver toxicity
Bone marrow suppression and leukopenia (low white blood cells)
It is teratogenic (harmful to pregnancy) and needs to be avoided prior to conception in mothers and fathers

Question 19

SE of Sulfasalzine

Answer 19

Temporary male infertility (reduced sperm count)

Bone marrow suppression

Question 20

SE of Hydroxychloroquine

Answer 20

Nightmares
Reduced visual acuity (macular toxicity)
Liver toxicity
Skin pigmentation

Question 21

Name some significant SE of DMARDS and biologics

Answer 21

Methotrexate: pulmonary fibrosis
Leflunomide: Hypertension and peripheral neuropathy
Sulfasalazine: Male infertility (reduces sperm count)
Hydroxychloroquine: Nightmares and reduced visual acuity
Anti-TNF medications: Reactivation of TB or hepatitis B
Rituximab: Night sweats and thrombocytopenia

Question 22

Summarise the SE of bisphosphonates

Answer 22

Reflux and oesophageal erosions. Oral bisphosphonates are taken on an empty stomach sitting upright for 30 minutes before moving or eating to prevent this.
Atypical fractures (e.g. atypical femoral fractures)
Osteonecrosis of the jaw
Osteonecrosis of the external auditory canal