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finals > PSA > Flashcards

PSA Flashcards

1
Q

side effects of spironolactone

A

dizziness

anti-androgenic (ie stops M hormones working) - gynaecomastia

could switch to eplerenone

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2
Q

amiodarone use and side effects

A

anti-arrhythmic med - wide complex supra-ventricular tachycardias

SEs

thyrotoxicosis- need TFTs monitoring

contains iodine
can be affected by grapefruit
sensitive to sunlight

Hypothyroidism (more common than hyperthyroidism)
Hyperthyroidism
Corneal deposits
Stevens-Johnson syndrome
Grey discoloration of the skin
Liver failure
Pneumonitis
Pulmonary fibrosis

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3
Q

what drug do you give for chemotherapy induced nausea

Any adverse affects

A

ondansetron (5-HT3-receptor antagonist)

adverse affect is prolonged QT interval, constipation is common

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4
Q

can you take verapamil and BBs at the same time? why?

A

no

possibility of heart block + fatal arrest

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5
Q

nicorandil

A

for angina tx

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6
Q

which abx can cause cholestasis

A

co-amoxiclav

flucloxacillin
erythromycin

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7
Q

what to check when starting a patient on azathioprine or mercaptopurine (for crohns)

A

+TPMT activity (an enzyme that metabolises these drugs, some ppl are deficient + wld have more adverse effects)

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8
Q

SE of adenosine

A

flushing, nausea, sweating, bronchospasm and also chest pain

warn about chest pain

short half life of 8-10 secs

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9
Q

CI of adenosine

A

asthma

The effects of adenosine are enhanced by dipyridamole (antiplatelet agent) and blocked by theophyllines.

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10
Q

what medication combo might cause rhabdomyolysis?

A

macrolides (clarithromycin) and statins

(Clarithromycin is an inhibitor of the P450 CYP3A4 isoenzyme -> increased levels of atorvastatin through reduced metabolism)
even higher risk in those w CKD

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11
Q

caution w isotretinoin (accutaine)

A

teratogenic

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12
Q

can you have ACEis b4 surgery

A

NO stop them

can get severe hypotension following anaesthesia

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13
Q

common SE of metformin

A

diarrhoea

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14
Q

what drug can reduce hypoglycaemic awareness

A

BBs

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15
Q

what anticoag to use w mechanical heart valves

A

warfarin

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16
Q

adverse effects of PPIs

A

hyponatraemia, hypomagnasaemia

osteoporosis → increased risk of fractures

microscopic colitis

increased risk of C. difficile infections

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17
Q

how do PPIs work

A

cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.

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18
Q

what medications might cause or worsen hypercalcaemia

A

thiazide diuretics
lithium
calcium
over-the-counter antacids
large doses of vitamin D

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19
Q

what is a risk of overreplacement with thyroxine

A

osteoporosis

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20
Q

how to prevent nitrate tolerance

A

px who take standard-release isosorbide mononitrate sld use an asymmetric dosing interval

(not needed if take OD modified release)

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21
Q

when are nitrates contraindicated

A

if hypotension < 90 systolic

inferior MIs

increased intracranial pressure

severe anemia

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22
Q

what are the rules whilst on steroids

A

DON’T – Don’t stop taking steroids abruptly. There is a risk of adrenal crisis.
S – Sick Day Rules.
T – Treatment Card.
O – Osteoporosis prevention with bisphosphonates and supplemental calcium and vitamin D.
P – Proton pump inhibitor for gastric protection.

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23
Q

contraception on methotrexate

A

Patients using methotrexate require effective contraception during and for at least 6 months after treatment in men or women

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24
Q

what cannot be prescribed w methotrexate

A

trimethoprim
(co-trimoxazole contains this)
(both folate antagonists + increase the risk of bone marrow suppression when prescribed together)

high dose aspirin

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25
Q

adverse effects of methotrexate

A

mucositis
myelosuppression
pneumonitis
- the most common pulmonary manifestation
- similar disease pattern to hypersensitivity pneumonitis secondary to inhaled organic antigens
- typically develops within a year of starting treatment, either acutely or subacutely
- presents with non-productive cough, dyspnoea, malaise, fever
pulmonary fibrosis
liver fibrosis

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26
Q

what to co-prescribe w methotrexate

A

folic acid 5mg once weekly, taken more than 24 hrs after methotrexate dose

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27
Q

how often to take methotrexate

A

weekly

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28
Q

what to monitor whilst on methotrexate

A

FBC, U&E and LFTs

before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months

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29
Q

what is the starting dose of methotrexate

A

7.5 mg weekly

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30
Q

tx for methotrexate toxicity

A

folinic acid

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31
Q

which abx is assoc w tendon disorders

A

quinolones - eg ciprofloxacin

TRIPflocloxacin

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32
Q

what drug can cause Dupuytren’s contracture

A

phenytoin

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33
Q

what are some side effects of adenosine

A

chest pain, impending feeling of doom, bronchospasm, transient flushing.

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34
Q

what drug enhances the affects of adenosine

A

dipyridamole (antiplatelet agent)

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35
Q

what drug blocks the affects of adenosine

A

theophyllines

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36
Q

what is the mechanism of action of adenosine

A

causes transient heart block in the AV node

agonist of the A1 receptor in the atrioventricular node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux

adenosine has a very short half-life of about 8-10 seconds

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37
Q

what cannula to use for adenosine + why

A

large-calibre due to its short half life

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38
Q

what drugs to avoid in HOCM

A

ACEis + nitrates

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39
Q

what to avoid in elderly px taking warfarin + why

A

NSAIDs
risk of a life-threatening gastrointestinal haemorrhage

40
Q

which drugs should you avoid in renal failure

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

41
Q

which drugs are likely to accumulate in CKD - need dose adjustment

A

most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
digoxin, atenolol
methotrexate
sulphonylureas
furosemide
opioids

42
Q

which drugs are safe in CKD

A

antibiotics: erythromycin, rifampicin
diazepam
warfarin

43
Q

what opioid to use in renal failure

A

eGFR < 30 –> Oxycodone
eGFR < 15 –> Fentanyl

44
Q

mechanism of action of aspirin

A

non-selective cyclooxygenase (COX) inhibitor that blocks the production of thromboxane A2 by platelets.
This impairs platelet aggregation.

45
Q

mechanism of action of warfarin

A

vitamin K antagonist that inhibits the vitamin K-dependent coagulation factors (II, VII, IX and X)

46
Q

mechanism of action of bisphosphonates

A

analogues of pyrophosphate, a molecule which decreases demineralisation in bone

They inhibit osteoclasts (which chew bone) by reducing recruitment and promoting apoptosis

47
Q

adverse effects of bisphosphonates

A

oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
osteonecrosis of the jaw

increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

acute phase response: fever, myalgia and arthralgia may occur following administration

hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant

48
Q

counselling for px 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 (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet’

49
Q

what to correct before starting bisphosphonates

A

Hypocalcemia/vitamin D deficiency

However, when starting bisphosphonate treatment for osteoporosis, calcium should only be prescribed if dietary intake is inadequate. Vitamin D supplements are normally given.

50
Q

when to stop taking bisphosphonates after 5 years

A

patient is < 75-years-old
femoral neck T-score of > -2.5
low risk according to FRAX/NOGG

51
Q

what drugs to not take with lithium

A

diuretics (especially thiazides)
ACEis/ARBs
NSAIDs
metronidazole

52
Q

on what occasions do you give anti hypertensive treatment

A

aged less than 80 years with stage 1 hypertension (<135/85) with one or more of:
- target organ damage
- established cardiovascular disease
- renal disease
- diabetes
- 10 year cardiovascular risk of 10% or more.

stage2 HTN regardless of age (>150>95)

53
Q

which drugs can cause SIADH

A

sulfonylureas - glimepiride and glipizide
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide

54
Q

side effect of hydroxychloroquine

A

bull’s eye retinopathy - irreversible damage to retina causes loss of central vision

55
Q

side effect of digoxin

A

yellow-green vision

56
Q

side effects of levodopa

A

reddish discolouration of urine upon standing
dyskinesia
‘on-off’ effect
hypotension

57
Q

side effect of Sildenafil

A

visual disturbances such as blue discolouration or non-arteritic anterior ischaemic neuropathy

58
Q

what tests to do before starting amiodarone

A

TFTs,LFTs,CXR,ECG

59
Q

what drugs can cause liver cholestasis

A

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates

60
Q

what drugs can cause liver cirrhosis

A

methotrexate
methyldopa
amiodarone

61
Q

what drugs to stop if you suspect a px has AKI

A

DAMN
Diuretics + digoxin
ACEi/ARBs
Metformin + methotrexate
NSAIDs

Contrast media
Some abx
allopurinol

62
Q

what do cytochrome p450 inducers do

A

speed up the metabolism of some drugs that use p450 to metabolise

63
Q

examples of cytochrome p450 inducers

A

CRAP GPs

Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
St John’s Wort/Sulfonylureas/Smoking

64
Q

examples of cytochrome p450 inhibitors

A

SICKFACES.COM

Sodium Valproate
Isoniazid
Cimetidine
Ketoconazole (+fluconazole)
Fluoxetine (+sertraline)
Amiodarone/ Allopurinol
Ciprofloxacin
Erythromycin
Sulfonamides
Chloramphenicol
Omeprazole
Metronidazole

65
Q

what change in bloods can corticosteroids cause

A

neutrophilia

66
Q

SEs Nicorandil

A

may cause ulceration anywhere in the gastrointestinal tract

(a vasodilatory drug used to treat angina)

67
Q

most common indications for DOACs

A

Stroke prevention in patients with AF
Treatment of DVT and PE
Prophylaxis of venous thromboembolism (DVTs and PEs) after a hip or knee replacement

68
Q

target INR for AF

A

2-3

69
Q

what is INR

A

international normalised ratio

used to assess how anticoagulated the px is by warfarin

calculates the px’s prothrombin time compared with the prothrombin time of an average healthy adult

1 = a normal prothrombin time. 2 = a prothrombin time twice that of an average healthy adult (it takes them twice as long to form a blood clot)

70
Q

how can INR be affected by other drugs and why

A

The metabolism of warfarin involves the cytochrome P450 system in the liver.

Therefore, the INR will be affected by other drugs that influence the activity of the P450 system, including many antibiotics.

71
Q

what foods can affect INR

A

those that contain VK e.g. leafy green veg

those that affect the P450 system, such as cranberry juice and alcohol

72
Q

warfarin half-life

A

1-3 days

73
Q

adverse affects of statins

A

myopathy- includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase.

liver impairment

some evidence that statins may increase the risk of intracerebral haemorrhage in patients who’ve previously had a stroke (so avoid if hx IC haemorrhage)

74
Q

CI to statins

A

macrolides (e.g. erythromycin, clarithromycin) - stop until course is completed
pregnancy

75
Q

statins mechanism of action

A

inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.

76
Q

what to check + when if on statins

A

checking LFTs at baseline, 3 months and 12 months

tx should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

77
Q

indications for statins

A

all people with established CVD (stroke, TIA, ischaemic heart disease, peripheral arterial disease)

anyone with a 10-year cardiovascular risk >= 10%

patients with T2DM should now be assessed using QRISK2, to determine whether they should be started on statins

patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

78
Q

when to take statins

A

at night when the majority of cholesterol synthesis takes place

79
Q

what might you see on ECG w cardiac tamponade

A

electrical alternans - different amplitude QRSs

80
Q

what drugs are RF for long QT syndrome

A

citalopram (+ other SSRIs)
amiodarone
TCAs
fluconazole
erythromycin
metaclopramide
quinidine
haloperidol
methadone
ondansetron

81
Q

SEs quinolone antibiotics eg ofloxacin, levofloxacin and ciprofloxacin (gd g-ve cover)

A

Tendon damage and tendon rupture, notably in the Achilles tendon
Lower seizure threshold (caution in patients with epilepsy)

82
Q

causes of drug induced lupus

A

Most common causes
procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

83
Q

do you take HRT before surgery

A

stop it 4 weeks before surgery

84
Q

do you take COCP before surgery

A

stop it 4 weeks before surgery

85
Q

when to avoid nitrofurantoin

A

renal failure
i.e. eGFR < 45

86
Q

SEs interferon alpha

A

flu-like symptoms and depression

87
Q

drugs that can cause lymphadenopathy

A

allopurinol
phenytoin
atenolol
carbamazepine

88
Q

what happens on ECG w digoxin

A

downsloping ST depression (reverse tick)

89
Q

how to change levothyroxine dose according to TSH level

A

target range = 0.5-5
unless grossly hypo/hyper, change by smallest increment offered

90
Q

what can long term steroid use cause

A

avascular necrosis of hip

91
Q

what to check before tx w azathoprine

A

check for thiopurine methyltransferase deficiency (TPMT)
- otherwise px may be prone toxicity

92
Q

what to do before starting someone on hydroxychloroquinine

A

baseline ophthalmologic examination - risk of bull’s eye retinopathy

93
Q

what time of day to give pred

A

morn

94
Q

when to check ketones in T1DM

A

if BM > 15

95
Q

key thing to tell px on insulin for T1DM

A

seek urgent medical help if unable to drink fluids due to N&V

finals (27 decks)

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