Common medication side effects

Question 1

Ladder of severity of dystonias from typical antipsychotics

Answer 1

Torticollis: Unilateral neck pain and restriction of motion
Oculogyric crisis: Sustained upwards deviation of eyes and clenched jaw with hyperextension of back/neck
Neuroleptic malignant syndrome: Medical emergency. Altered mental state, rigidity, fever, fluctuating BP and high temperature.

Question 2

Chronic dystonia from typical antipsychotics

Answer 2

Tardive dyskinesia occurs in patients on long term typical antipsychotics. uncontrolled facial movement and lip-smacking.
Akathisia is also a chronic symptom of restlessness in patients on long term antipsychotics

Question 3

Antipsychotics receptor of action

Answer 3

D2 dopamine: blocks mesolimbic pathways.
EPSEs are common: dystonia, parkinsonism, akathisia, tardive dyskinesia- can be managed with procyclidine.
Increased risk of stroke and VTE

Question 4

Common side effect profile of Antipsychotics

Answer 4

Anti-muscarinic side effects; dry mouth, blurred vision, urinary retention.
Occasionally proactinaemia: galactorrhoea - inhibition of the dopaminergic tuberinfundibular pathway
Impaired glucose tollerance.
More sevrely - Neuroleptic malignant syndrome, seizures and QT prolongation

Question 5

Acute interstitial nephritis presentation

Answer 5

Triad of rash, fever, eosinophilia. Typically with Beta lactams. Typically occurs with the initiation of the drug

Question 6

Vasculitis post medication use timeline

Answer 6

typically 7 -10 days

Question 7

Nitrofurantoin

Answer 7

Lung fibrosis

Question 8

Management of oculogyric crisis

Answer 8

Benztropine or procyclidine

Question 9

Causes of raised anion gap metabolic acidosis

Answer 9

CAT MUDPILE
Carbon monoxide, cyanoide, caffeine, aceaminophen and aspirin, theophyline

Methanol, metformin
Uraemia
DKA
Propylene glycol
Isoniazid, ibuprofen, iron
Lactic acidosis 
Ethylene glycol

Question 10

Causes of normal anion gap metabolic acidosis

Answer 10

ABCD: Addisons, Bicarb loss (GI, Renal including RTA), Chloride, Drugs (Acetazolamide, acids)

Question 11

First line therapy for ethylene glycol toxicity

Answer 11

Fomepizole, otherwise can use ethanol

Question 12

MOA of Aspirin

Answer 12

non-reversible Cox 1 and 2 inhibitor

Question 13

MOA of Dipyriudamole

Answer 13

Phosphodiesterase 3 inihibitor : reduces intracellular cAMP and cGMP

Question 14

Name 2 P2Y12 inihibitors

Answer 14

Clopidogrel and ticagrelor

Question 15

MOA Abciximab, eptifibatide, tirofiban

Answer 15

GP IIa/IIIb inhibitor. Prevent platelets aggregating with fibrinogen

Question 16

Indications for liver transplantation in paracetamol associated liver failure

Answer 16

Arterial pH <7.3 
OR ALL OF THE FOLLOWING 
1. PT >100 seconds
2. CR >300
3. Grade III or IV encephalopathy

Question 17

Conditions that benefit from IVIG

Answer 17

GIMMiCK
GBS
ITP
MS
MG
CIDP
Kawasaki