Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MRCP Part 1 > Clinical Pharmacology and Toxicology > Flashcards

Clinical Pharmacology and Toxicology Flashcards

(92 cards)

Start Studying
1
Q

Carbon Monoxide Poisoning

  1. Features
  2. Investigation
  3. Treatment
A

Falsely Normal SpO2
Low PaO2

ECG
Flattening of Oxygen Dissociation Curve

100% oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

P450 Enzyme INHIBITOR Mnemonic
SICKFACES.COM

A

Sodium Valproate
Isoniazid
Cimetidine
Ketoconazole

Fluconazole
Alcohol Binge Drinking
Chloramphenicol
Erythromycin
Sulphanamides

Ciprofloxacin
Omeprazole
Metronidazole
Grape Fruit Juice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

P450 Enzyme Inducer Mnemonic
CRAP GPS

A

Carbamezepine
Rifampicin
Alcohol (Chronic)
Phenytoin
St John Warts

Greiosulvin
Phenobarbitone
Sulphonyl urea / SMOKING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which CCB causes Gingival Hyperplasia

A

Amlodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Teratogenic Drugs Menmomnic

A

SAFE Moms Take Really
Good Care = WIN

Sulphonamides/ Statins
Aminoglycosides/ACEi
Fluoroquinolones
Erythromycin/Estradiol
Metronidazole
Tetracyclines/Trimethoprim
Ribavirin/Retinoids
Griseofulvin
Chloramphenicol/Clomiphene citrate

Warfarin
Isoniazid
Nitroimidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Metformin MOA

A

Biguanide

activation of the AMP-activated protein kinase (AMPK)

Increasing Glucose Sensitivity and Decreasing Hepatic Gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Contraindications for Metformin

A

eGFR < 30 or Creat > 130

Reviewed if eGFR < 45 and Creat > 130

Contraindicated if Tissue Hypoxia States (precipitate Lactic Acidosis) - Recent MI , Sepsis , AKI etc ….

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Side Effects of Metformin

A

GI Upset and Lactic Acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long should you leave before you increase dose of Metformin ?

A

1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If patients develop side effects on Immediate Release Metformin then what ?

A

Switch to Modified Release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gentamicin

If the Peak Level is High = What to do ?
If the Trough Level is High = What to do ?

A

Peak High = Reduce Dose

Trough Level is High = Increase the Gap between doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Contraindication for Gentamicin ?

A

MG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Quinolones MOA

A

inhibit topoisomerase 2 (DNA gyrase) and topoisomerase 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mechanism of Resistance of Quinolones

A

Mutations to DNA gyrase

Efflux pumps which reduce intracellular quinolone concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Side Effects of Quinolones

A

Lower Seizure Threshold
Tendon Rupture (Especially if on Steroids)
QT Prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When to Avoid Quinolones ?

A

G6PD
Pregnancy / Breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When to give Hyperbaric Oxygen in CO Poisoning ?

A
  • CO level >25 percent
  • CO level >20 percent in pregnant patient
  • Loss of consciousness
  • Severe metabolic acidosis (pH <7.1)
  • Evidence of end-organ ischemia (eg, ECG changes, chest pain, or altered mental status)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Motion Sickness What Sequence of Drugs ?

A

Hyoscine
Cyclizine
Promethazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Digoxin MOA ?

A

Inhibition of the Na+/K+ ATPase pump in
Cardiac Muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Features of Digoxin Toxicity ?

A

Yellow Green Vision
Gynecomastia
BRADYCARDIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Check Digoxin Levels in Patients with Digoxin Toxicity how often ?

A

8 to 12 hours after last dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What Precipitates Digoxin Toxicity ?

A

Digoxin competes for same site as K at ATPase

Hypokalemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which Drugs Precipitate Digoxin Toxicity ?

A

Amiadorone
Diltiazem
Verapamil
Quinidine
Ciclosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Precipitants of Digoxin Toxicity ?

A

Half Empty (MT) Packet of Chips (PKT)

Mg , Temp , pH, K, Thyroid

Full Can of Coke (CaN)
High Ca and Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Ethylene Glycol Poisoning Treatment?
Fomepizole - Inhibit Alcohol Dehydrogenase BUT Ethanol in the past competes for Alcohol Dehydrogenase
26
Traztusumab MOA and Side Effect
HER 2 Receptor blocker Cardiotoxicity so do Echo before starting
27
Ethambutol MOA ?
Inhibits Arabinose Transferase which converts Arabinose to Arabinan
28
Which TB drug has renal dosing ?
Ethambutol eGFR<30
29
Lithium Side Effects ?
Leukocytosis Increased Urine (Nephrogenic DI) Thirst/Tremor (Coarse vs Tremor (when in therapeutic levels)) Hypothyroidism Upset Stomach Mental (Seizures/Coma)
30
Lithium Treatment
3C's - confusion convulsion coma if present, along with lithium = ABC + emergent hemodialysis if not, ABC + IV Saline + check lithium levels (4 hourly if DI) + assess for DR. DAMN DR. DAMN - dehydration + renal fail + diuret. + acei + metronid. + nsaids
31
Lithium Toxicity (>1.5) Precipitants ?
Drugs (ACEi, Thiazide, NSAID's, Metronidazole) AKI Dehydration
32
Caustic Agent Ingestion Treatment
Urgent OGD if Symptomatic (drooling, vomiting, dysphagia, odynophagia, chest pain) IV PPI If Asymptomatic - Trial Oral Fluid and Discharge If Signs of Perf (Mediastinal Widening or Surgical Emphysema) = Upper GI Referral
33
Side Effect of Hydrofluoric Acid ingestion ?
Hypocalcemia
34
How often to Monitor Lithium Ciclosporin Digoxin Phenytoin
6 hours Post Dose Immediately Before Dose 12 hours Post Dose Immediately Before Dose
35
Cyanide Poisoning MOA ?
Cyanide Inhibits Cytochrome C which results in halting of the Mitochondrial ETC
36
Cyanide Poisoning Treatment ?
Hydroxocobalamin Combination of Inhaled Amyl Nitrite + IV Sodium Nitrite + Sodium Thiosulfate
37
Adrenaline Induced Digital Ischemia Treatment ?
Topical Application of Nitroglycerin then Phentolamine - Short Acting Alpha Blocker
38
Ciclosporin Side Effects
CiclosporINCREASES everything: fluid, BP, K+, hair, gums, glucose, creatinine, lipids, infections. Only 2 toxicities (nephro and hepatic)
39
What increases level of Ciclosporin ?
Cannabinoid
40
Drugs having Zero Order Kinetics ?
High Dose Aspirin Phenytoin Heparin Ethanol
41
Drugs affected by Acetylator Status ?
Isoniazid Procainamide Hydralazine Dapsone Sulfasalazine SHIP - D
42
Drugs undergoing First Pass Metabolism ?
Aspirin Isosorbide dinitrate GTN Lidocaine Propranolol Verapamil Isoprenaline Testosterone Hydrocortisone
43
Which Drug causes Anal Ulceration ?
Nicorandil
44
Which Anti-Anginal Causes Sleep Disturbance (vivid dreams) ?
Beta Blocker
45
DRESS Syndrome Diagnostic Criteria ?
Triad of Skin Rash + Fever + Organ Involvement At least 3 of the following: 1. Hospitalization 2. Reaction suspected to be drug related 3. Acute skin rash 4. Fever about 38ºC 5. Enlarged lymph nodes at two sites 6. Involvement of at least one internal organ 7. Blood count abnormalities such as low platelets, raised eosinophils or abnormal lymphocyte count.
46
Phase 1 Reactions
Hydrolysis , Reduction and Oxidation Caused by Enzymes : P450 or Alcohol Dehydrogenase or Xanthine Oxidase
47
Side Effects of Sildanefil (PDE5i)
NOID (Non-Arteritic Anterior Ischaemic neuropathy) Bluish Discoloration of Vision Nasal Congestion Flushing
48
When not to take Sildanefil ?
Concomitant Nitrates Recent MI (wait 6 months)
49
Cannabis Toxicity 1. Features
Coronary Neurological Psychiatric Other - Ischemic Colitis Rhabdomyolysis Metabolic Acidosis Hyperthermia
50
Cannabis Toxicity 2. Treatment
NSTEMI - IV Benzo + GTN STEMI - PCI STAT !!!! HTN - Nitroprusside + BZD
51
Drugs Causing Impaired Glucose Tolerance
TASTINg Sugar Thiazides, Antipsychotics, Steroids, T cell in inhibitors (tacrolimus |&| cyclosporin), interferon alpha, Nicotinic acid. Sugar = impaired glucose tolerance
52
Most Common Side Effect of Finasteride ?
Gynecomastia
53
Drugs causing Gynecomastia
DISCO with GF Digoxin Isoniazid Spironolactone Cimetidine OEstrogen Goserlin Finasteride
54
What drug can be discontinued abruptly when starting Sildenafil ?
Alpha Blockers Stopped for 4 hours AFTER Sildenafil Nateglinide used in Diabetic Control Doxazosin would need to be adjusted because the time taken will need to be changed.
55
Heparin Induced Thrombocytopenia
See Note from HaemoOncology !!!
56
Which Factor does LMWH inhibit ? vs Standard Heparin ?
LMWH - Antithrombin III but SPECIFICALLY 10a Standard - Antithrombin III (10 2,7,11,12,9)
57
Side Effects of Heparins ?
Osteoporosis Thrombocytopenia (HIT) Hyperkalemia (inhibition of aldosterone secretion)
58
MOA 1. Statins (Myositis) 2. Ezetimibe 3. Nicotinic acid (Myositis) 4. Fibrates (Myositis) 5. Cholestyramine
HMG CoA Reductase inhibitor Decreases Cholesterol Absorption via NPC1L1 (Niemann-Pick 1 like 1) Decreases Hepatic VLDL Secretion PAPP-R agonist --> Increasing Lipoprotein Synthesis Bile Acid Sequestrant
59
Which Anti - Lipid Drug Potentiates Myositis from Statins ?
Fibrates !!!
60
Tacrolimus MOA and how is it different to Ciclosporin ?
Bind to FKMB --> Inhibit Calcineurin --> Prevent Dephosphorylation of Transcription Factor NF-AT --> Inhibit release of IL-2 Vs Ciclosporin Bind to cyclophilin --> Inhibit release of IL-2
61
MOA of MMF ?
Inhibits inosine monophosphate dehydrogenase --> Decreasing G base pairs for DNA / RNA Synthesis
62
Drugs that can be cleared by Hemodialysis ?
Barbiturate Lithium Alcohol (Methanol and Ethylene Glycol) Salicylate Theophylline (Charcoal Hemodialysis)
63
Drugs that CANNOT be cleared by hemodialysis ?
TCA BB Digoxin BZD Dextropropoxyphene (Co-proxamol)
64
Drugs causing Urticaria ?
P(I)ANO penicillin's aspirin NSAIDs opiates
65
MDMA associated with which electrolyte derangement ?
Hyponatremia
66
Drugs causing Photosensitivity Rash ?
SAN LIGHT Sulphanamides Amiodarone NSAIDs Loop Diuretics Isoniazid Griseofulvin Hydrochlorothiazide Tetracyclines OR PQRST AND CNG P- Psoralens Q- Quinine, Quinolones, Quinidine R- Retinoids S- Sulphonamides, Sulfonylureas T- Tetracyclines, Thiazides A- Amiodarone N- NSAID'S-- Ibuprofen, naproxen, celecoxib D- Dapsone C- Chloroquine, Chlorpromazine N- Nalidixic acid G- Griseofulvin
67
Cetuximab (Anti Epidermal Growth Factor) Alemtuzumab (Anti CD52) Abciximab (Anti Glycoprotein IIb/IIIa) OKT3 (Anti - CD3)
Monoclonal Antibodies Created via STEM CELL HYBRIDIZATION Myeloma Cells + Mouse Spleen Cells sensitivised for Antigens = Hybridoma Humanising is when Fc Portion from Human is attached to the Mice FaB
68
Drugs causing Thrombocytopenia ?
HARDPANS Q (kinda looks like a pan) - Heparin - Anticonvulsants: carbamazepine, valproate - Rifampicin - Diuretics: furosemide - Penicillin - Abciximab - NSAIDs - Sulphonamide - Quinine
69
Drugs precipitating AIP ? Induce P450 --> Increasing Heme Synthesis --> Depleting Heme Storage --> Attack
SHABOB Sulphanamide Halothane Alcohol Barbiturates Ora Contraceptive Pill BZD
70
Methanol vs Ethylene Glycol Poisoning How to differentiate
Vision Disturbance in Methanol but not in Ethylene Glycol
71
Which drug causes Corneal Opacification ?
Corneal opacification --> Amiodarone , Indomethacin Lens opacification --> Steroids
72
Local Anesthetic Toxicity Antidote ?
IV Lipid Emulsion 20%
73
MOA of Ketamine ?
NMDA Antagonist BarbiDurates=increase Duration Frenzodiazipine=increase frequency
74
Is Aspirin a Reversible or Non Reversible COX 1 and 2 inhibitor ?
IRREVERSIBLE
75
Mercury Poisoning Features ?
M - Muscle weakness + PN E - Eye (Visual field defect) + Ear (SNHL) R - RTA-P → Hyperchloraemic metabolic acidosis C - aCrodynia → Pain + Pink discoloration → Hand + Foot U - ↓Urine → Renal impairment R - Restless → Irritability Y - enzYme - Inhibition of selenoenzyme → end-organ oxidative damage
76
MDMA + SSRI = Which Crisis ?
Serotonin Crisis
77
Cyanide Poisoning
Read Attached Note and Watch Medicosis
78
Alpha 1 = Phenylephrine Alpha 2 = Clonidine Beta 1 = Dobutamine Beta 2 = Salbutamol Beta 3 = Mirabegron
79
When to give IV HCO3- in TCA OD ?
pH <7.1 QRS >160 ms Arrhythmias Hypotension
80
MOST COMMON Side effect of Progesterone Only Pill ?
endometrium pops (irregular periods) BUT also Head pops (headache), breasts pop (breast tenderness), Tummy pops (weight gain) and skin pops (acne),
81
TB Drugs Side Effects
Rifampicin - Orange Isoniazid - Peripheral Neuro Pyrazinamide - Gout , Hepatitis Ethambutol - RBR
82
Amiodarone Induced Hypothyroidism vs Amiodarone Induced Thyrotoxicosis
Continue Amiodarone Add Levothyroxine Stop Amiodarone AIT Type 1 (Excess Iodine) - Carbimazole or Potassium Perchlorate AIT Type 2 (Destructive Thyroiditis) - Corticosteroids
83
Difference between AIT Type 1 and Type 2 Which has Goitre ?
Type 1 has Goitre
84
Drugs NOT safe in Pregnancy ?
Sulphanamides/Statins Aminoglycosides/ACEi (Renal Agenesis) Fluroquinolones Erythromycin/Estadiol Metronidazole Tetracyclines (Discoloured Teeth) Rivabarin/Retinoids Griseofulvin Chlormphenicol (Gray Baby Syndrome) Diethylstilbesterol - Vaginal Clear Cell Adenocarcinoma
85
Methadone MOA Buprenorphine MOA
Methadone - Full agonist of the mu-opioid receptor Buprenorphine - Full Kappa and Partial Mu
86
Detoxification Monitored via How ? for How Long ?
Urinalysis 4 weeks in Hospital 12 weeks in Community
87
Side Effect of Octreotide ?
Biliary Stasis
88
Treatment for Methanol Poisoning
fomepizole (competitive inhibitor of alcohol dehydrogenase) Ethanol Haemodialysis cofactor therapy with folinic acid to reduce ophthalmological complications
89
Upper Extremity Nerve Injury Video to Watch
ARM - U NAMe SOME Watch https://www.youtube.com/watch?v=Orr4KPUr9Ck&t=302s
90
Cinconism
Tinnitus Hypoglycemia Flash Pulmonary Edema Prolonged QT interval
91
Most Common Cancer in Lower Lip ?
Squamous Cell Carcinoma
92
Drugs causing Alopecia ?
CCCCC - cytotoxic, carbimazole, contraceptive, colchicine, clexane ALOPECIA A- anticancer drugs like cycophosphamide, adriamycin L- lithium O- OCP withdrawal P- PTU E- ethiomide, C- colchicine, carbimazole I- interferons A- anticoagulant like heparin, Vit A excess

MRCP Part 1 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions