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MRCP p1 > clinical pharm > Flashcards

clinical pharm Flashcards

1
Q

Which drugs inhibit calcineurin?

A

ciclosporin
tacrolimus

inihibits calcineurin thus decreasing IL-2

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2
Q

how does octreotide work in acute variceal haemorrhage?

A

It works by reducing splanchnic blood flow thereby decreasing portal pressure which helps to control bleeding from oesophageal and gastric varices.

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3
Q

what are the side effects of trastuzumab?

A
  • flu like symptoms and diarrhoea are common
  • cardiotoxicity - more common when anthracyclines have also been used

echo to be done before starting treatment

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4
Q

how does metformin work?

A

Biguanides such as Metformin act by activating the AMP-activated protein kinase (AMPK), helping cells to respond more effectively to insulin and take in glucose from the blood.

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5
Q

how does sulfonylurea work?

A

Sulfonylureas bind to and close ATP-sensitive potassium (K-ATP) channels on the cell membrane of pancreatic beta cells, which depolarises the cell by preventing potassium from exiting.

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6
Q

how is cocaine toxicity managed?

A

chest pain - benzodiazepines + glyceryl trinitrate

hypertension: benzodiazepines + sodium nitroprusside

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7
Q

what is the mode of action of digoxin?

A
  • Decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
    increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve
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8
Q

what are the drugs that cause urticaria?

A

NAPPY

Nsaids, Aspirin, Penicillin , Op(py)iates

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9
Q

what is part of the king’s college hospaital creirta for liver transplantation??

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
- prothrombin time > 100 seconds
- creatinine > 300 µmol/l
- grade III or IV encephalopathy

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10
Q

how does N-Acetylcistein work?

A

The liver normally conjugates paracetamol with glucuronic acid/sulphate. During an overdose the conjugation system becomes saturated leading to oxidation by P450 mixed function oxidases*. This produces a toxic metabolite (N-acetyl-B-benzoquinone imine)

Normally glutathione acts as a defence mechanism by conjugating with the toxin forming the non-toxic mercapturic acid. If glutathione stores run-out, the toxin forms covalent bonds with cell proteins, denaturing them and leading to cell death. This occurs not only in hepatocytes but also in the renal tubules

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11
Q

what is the tx for tricyclic overdose?

A

IV bicarbonate

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12
Q

what are the features of tricyclic overdose?

A

Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.

severe:
arrhythmias
seizures
metabolic acidosis
coma

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13
Q

how does ketamine work?

A

Ketamine is an NMDA receptor antagonist. It can be used in neuropathic pain poorly responsive to titrated opioids and oral adjuvant analgesics (e.g. antidepressant and/or anticonvulsant) particularly when there is abnormal pain sensitivity (e.g. allodynia, hyperalgesia or hyperpathia).

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14
Q

what are the inhibitors of CYP450?

A

SICKFACES.com

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluoxetine
Chloramphenicol
Erythromycin
Sulfonamides
Criprofloxacin
Omeprazole
Metronidazole
Grapefruit juice

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15
Q

what are the inducers of CYP450?

A

BS CRAP GPS (inducers)

Barbiturates
st johns wort

Carbemazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas

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16
Q

why does methanol poisoning cause visual problems?

A

a common complication of methanol poisoning. A metabolite of methanol, formic acid, accumulates in the optic nerve causing visual disturbance and eventually blindness.

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17
Q

what is the tx for methanol poisoning?

A

fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol

18
Q

how do you differentaite methaemaglobin, CO poisoning and cyanide poisoning?

A

Methaemaglobin - normal pO2, low SpO2

CO poisoning - low pO2, low or false normal SpO2

Cyanide poisoning - normal pO2 and SpO2

19
Q

how does cyanide work?

A

Cyanide inhibits the enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain.

20
Q

what are the drugs to avoid in renal failure?

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

21
Q

what drugs cause photosensitivity?

A

SCANTy clothing causes sunburn

Sulphonamides
Ciprofloxacin
Amiodarone
NSAIDS
TetracYclines/thiazides

22
Q

drugs that impair glucose tolerance?

A

TASTINg Sugar( impared glucose tolerance)

Thiazides, Antipsychotics, Steroids, T cell in inhibitors(tacrolimus |&| cyclosporin), interferon alpha, nicotinic acid.

Sugar = impared glucose tolerance

23
Q

what is the tx for serotonin syndrome?

A

Cyproheptadine is an H1 and nonspecific 5HT antagonist

24
Q

how does finasteride work?

A

inhibitor of 5 alpha-reductase, an enzyme which metabolises testosterone into dihydrotestosterone.

25
Q

what are drugs that follow zero order kinetics?

A

zero order kinetics: where the rate of excretion is constant despite changes in plasma concentration, this is due to saturation of the metabolic process

WATT Power

Warfarin
Aspirin/ Alcohol
Theophylline
Tolbutamide
Phenytoin

26
Q

what is the mx of beta-blocker overdose?

A

atropine + glucagon

27
Q

what are the drugs that can be cleared by haemodialysis?

A

BLAST -

Barbiturate, Lithium, Alcohol, Salicylate, Theophylline.

drugs are cleared by RRT if they
are water-soluble and not highly protein-bound

28
Q

what other meds can be used in hyperlipidaemia?

A

statin

ezetimibe - decreases cholestrol absorption in the small intestine (SE: headaches)

Nicotinic acid - decreases heaptic VLDL secretion (flushing, myositis)

Dibrates - agonist of PPAR-alpha therefore increases lipoportein lipase expression - (SE: myositis, pruritus , cholestasis)

29
Q

what are the drugs that can cause nightmares and sleep disturbance?

A

Beta blockers
Amiodarone
Monteleukast
Verapamil
Levodopa
Amitryptyline

30
Q

which drugs levels need to taken at specific times to check levels?

A

Lithium - take 12 hrs post dose

ciclosporin - trough levels immediately before dose

digoxin - at least 6 hrs post -dose

phenytoin - trough levels immediately before dose - if suspected toxicity or adjustment of phenytoin dose

31
Q

when do you administer sodium bicarbonate in TCA overdose?

A

Give sodium bicarbonate (50 ml of 8.4%) if:
-pH <7.1
-QRS >160 ms
-Arrhythmias
-Hypotension

32
Q

what are the features of quinine overdose?

cinchonism

A

ECG changes
hypotension
metabolic acidosis
hypoglycaemia
classically tinnitus, flushing and visual disturbance

Flash pulmonary oedema

33
Q

what can precipitate lithium toxicity?

A

reanl failure
drugs that affect renal function (diuretics, ACE-i, NSAIDs)

+
metronidazole

34
Q

what are the features of ethylene glycol toxicity?

A

Stage 1: symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness

Stage 2: metabolic acidosis with high anion gap and high osmolar gap. Also tachycardia, hypertension

Stage 3: acute kidney injury

35
Q

what is the typical features of mercury poisoning?

A

paraesthesia
visual field defects
hearing loss
irritability
renal tubular acidosis

36
Q

how does cetuximab work?

A

epidermal growth factor receptor antagonist

37
Q

what are the drugs that affect the acetylator status?

A

SHIP; Sulfonamides (including dapsone) Isoniazid Hydralazine Procainamide

38
Q

what are the side effects of ciclosporin?

A

Ciclosporin side-effects: everything is increased - fluid, BP, K+, hair, gums, glucose

39
Q

what are the features of organophosphate poisoning?

A

everything is wet
SLUD

Salivation
Lacrimation
Urination
Defecation/diarrhoea

small pupils

40
Q

what is the tx for caustic substance ingestion?

A

NBM
IV PPI
urgent oesophago-gastroduodenoscopy

41
Q

which of the medications can precipitate acute intermitted porphyria?

A

Blood Problems Have A Sneaky Behaviour

Barbiturates
Pill- OCP
Halothane
Alcohol
Sulphonamides
Benzodiazepines

42
Q
A

MRCP p1 (13 decks)

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