CPT Flashcards

Question

How many subtypes of CyP450 are there?

Answer 1

CyP3A4 \>30% e.g. CCBs, beta blockers, statins, benzos

Answer 2

CyP2D6 \>20% e.g. antidepressants, some beta blockers, opiates

Answer 3

Enalprilat

Answer 4

Ez-glucuorinde

Answer 5

alpha-methylnorepinephrine

Answer 6

6-mercaptopurine (by xanthine oxidase)

Answer 7

Methimazole

Answer 8

4-hydroxycyclophosphamide

Answer 9

Genetically determined variation in drug response

Answer 10

Fast vs slow acetylators e.g. fast in Japan vs Europe

Answer 11

Isoniazid Hydralazine Dapsone

Answer 12

Oxidative stress-\> haemolysis

Answer 13

Quinolones, primaquine, nitrofurantoin, dapsone

Answer 14

Type A Type B Long term ADR Delayed ADR

Answer 15

Common, predictable reactions Dose-related but may occur at therapeutic doses Consequences of known pharmacology of the drug

Answer 16

Rare, idiosyncratic reactions Usually not dose related E.g. allergies and pharmacogenetic variations

Answer 17

Dependence, addiction Withdrawal phenomena Adaptive changes e.g. tardive dyskinesia

Answer 18

Carcinogenesis Teratogenesis

Answer 19

Pharmacodynamics Pharmacokinetics Dose Formulation Route of administration Rate of administration

Answer 20

Age Co-morbidities Renal- digoxin, aminoglycosides Hepatic: warfarin, opiates Organ dysfunction Genetic predisposition

Answer 21

Penicllins, contrast media Anaphylaxis

Answer 22

e.g. causing haemolysis Penicillins, cephalosporins, oral hypoglycaemics Methyldopa

Answer 23

Immune-complex Serum sickness-like reaction Penicillins, sulphonamides

Answer 24

Cell-mediated Topical Abx, antihistamine cream

Answer 25

Pharmacological ADRs not immune

Answer 26

Bronchospasm Shift metabolism from prostaglandins-\> leukotrienes-\> bronchoconstriction May occur in non-asthmatic populations but commoner if asthmatic

Answer 27

Cough and angioedema (anaphylactoid) ACEI inhibit bradykinin metabolism

Answer 28

Opiates Benzos Corticosteroids

Answer 29

Worse on withdrawing the drug than before starting

Answer 30

Clonidine Beta-blockers Corticosteroids

Answer 31

Neuroleptics-\> tardive dyskinesia

Answer 32

Endometrial Ca Breast Ca

Answer 33

Penicllins Cephalosporins

Answer 34

Contrast Opiates NSAIDs

Answer 35

Sulfonamides NSAIDs Allopurinol Phenytoin Penicllin

Answer 36

Sulponhamides OCP

Answer 37

Amiodarone Thiazides Sulfonylureas

Answer 38

Erythromycin Sulphonamides

Answer 39

Hydralazine Isoniazid Penicillamine

Answer 40

Clavulanic acid (may be delayed) Fluclox: may be delayed Erythromycin Sulfonylureas (glibenclamide) OCP Tricyclics Chlorpromazine, prochlorperazine

Answer 41

Paracetamol VPA, phenytoin, CBZ Rifampicin, Isoniazid, **Pyrazinamide** Halothane Methotrexate Statins

Answer 42

Isoniazid Methyldopa Methotrexate

Answer 43

Cytotoxics Phenytoin Chloramphenicol Penicillamine Phenothiazines Methyldopa

Answer 44

Carbamezapine Carbimazole Clozapine Sulfasalazine

Answer 45

Valproate Salicylates Chloroquine

Answer 46

Isoniazid Vincristine Amiodarone Nitrofurantoin Penicilliamine

Answer 47

Bleomycin Busulfan Amiodarone Nitrofurantoin Sulfasalazine Methotrexate Methysergide

Answer 48

Spironolactone DIgoxin Verapamil Cimetidine Metronidazole

Answer 49

Carbamezapine Cyclophosphamide Chlorpropamide SSRIs TCAs

Answer 50

Nifedipine Phenytoin Ciclosporin

Answer 51

Fluoroquinolones: ciprofloxacin Venlafaxine Neuroleptics: phenothiazines, haldol Macrolides Anti-arrhythmics 1a/III: quinidine, amiodarone, sotalol TCAs Histamine antagonists

Answer 52

Salivation Bronchoconstriction Lacrimation Urination Diarrhoea GI upset Emesis Miosis Sweating e.g. anti-cholinesterases

Answer 53

Constipation Urinary retention Mydriasis Blurred vision Bronchodilation Drowsiness Dry eyes/skin

Answer 54

Ipratropium Anti-histamines TCAs Anti-psychotics Procyclidine Atropine

Answer 55

L-Dopa Da agonists

Answer 56

Behaviour change Confusion Psyhcosis

Answer 57

Anti-psychotics Anti-emetics: metoclopramide, prochlorperazine

Answer 58

EPSEs Increased prolactin Neuroleptic malignant syndrome

Answer 59

Dysdiadochokinesia, dysmetria, rebound Ataxia Nystagmus Intention tremor Scanning dysarthria/slurred speech Hypotonia

Answer 60

EtOH Phenytoine

Answer 61

Typical antipsychotics Rarely: metoclopramide, prochlorperazine: especially in youing women Dyskinesias and dystonias are common with anti-parkinsonian drugs

Answer 62

D2 block in the nigrostriatal pathway Excess AChM- hence the effect of anti-AChM

Answer 63

Parkinsonian Acute dystonia Akathisia Tardive dyskinesia Neuroleptic malignant syndrome

Answer 64

Occurs within months More common in the elderly Bradykinesia tremor, rigidity

Answer 65

Procyclidine

Answer 66

Occurs within hours-days of starting drugs Commoner in young males Involuntary sustained muscle spasm e.g. lock jaw, spasmodic torticollis, oculogyric crisis

Answer 67

Procyclidine

Answer 68

Occurs within days to months Subjective feeling of inner restlessness

Answer 69

Propranolol (crosses BBB)

Answer 70

Rhythmic involuntary movement of head, limbs and trunk Chewing, grimacing Protruding, darting tongue Occur in 20% of those on long term neuroleptics

Answer 71

Switch to atypical neuroleptic Clozapine may help Procyclidine worsens symptoms

Answer 72

4-10d after initiation or change of dose Mostly in young males Motor: severe muscular rigidity Mental: fluctuating consciousnsess Autonomic: hyperthermia, increased HR, sweating, hyper/hypotensive Blood: rasied CK, leukocytosis

Answer 73

Dantrolene: inhibits muscle Ca release Bromocriptine/apomorphine: reverse Da block Cool patient

Answer 74

Outside the body Mainly with IV drugs being mixed together e.g. Ca and NaHCO3-\> precipitation

Answer 75

Altered absorption Displacement from plasma proteins Metabolism- inhibitors and inducers Excretion

Answer 76

Tetracyclines and quinolones with Ca, Fe, Al Drugs chelate the metals and are not absorbed

Answer 77

Warfarin + some NSAIDs often clinically insignificant as clearance increases proportionally with displacement

Answer 78

P450 Xanthine oxidase: allopurinol DOPA decarboxylase: carbidopa Acetaldehyde dehydrogenase: disulfiram, metronidazole

Answer 79

Reduce Li clearance

Answer 80

Increase aminoglycoside ototoxicity

Answer 81

Diuretics and steroids-\> increase risk of digoxin toxicity by reducing K NSAIDs and warfarin increase risk of GI bleed Abx and warfarin increase bleeding risk as Abx kill GI microflora that make Vit K

Answer 82

Phenytoin Carbamezapine Barbiturates Rifampicin Alcohol (chronic) Griseofulvin St John's Wort

Answer 83

Valproate Isoniazid Protease inhibitors Ciprofloxacin Cimetidine Erythromycin and clarithromycin Omeprazole Grapefruit juice Fluconazole, fluoxetine

Answer 84

Ciclosporin OCP Warfarin Epileptic drugs: phenytoin, CBZ Statins Theophylline

Answer 85

Enzyme inhibitors EtOH Simvastatin NSAIDs Dipyridamole Amiodarone

Answer 86

Enzyme inducers

Answer 87

ACEI Li Digoxin

Answer 88

Increase risk of hyperkalaemia

Answer 89

Reduce body water- increased {water soluble drugs} Increased body fat- {reduced fat soluble drugs} Reduced albumin- [increased protein bound drugs] Reduced weight: therefore at standard dose- {increased]

Answer 90

Reduced oxidation Reduced FPM Reduced induction of liver enzymes Therefore with age there is an increased t1/2 of hepatically metabolised drugs

Answer 91

Reduced GFR Reduced tubular secretion

Answer 92

Increased age tends to lead to greater and longer drug effects

Answer 93

Defective compensatory mechanisms Reduced beta receptor density: therefore reduced effectiveness of drugs targeting them

Answer 94

Increased sensivity to anxiolytics and hypnotics

Answer 95

Reduced perfusion of liver and kidneys: reduced function: reduce metabolism or elimination of drug

Answer 96

Confusion Reduced vision Arthritic hands Living alone Polypharmacy

Answer 97

Anti-HTNs Digoxin Diuretics

Answer 98

Anti-depressants Anti-parkinsonian Hypnotics

Answer 99

A: reduced gastric motility D: immature BBB Increased body water: {reduced water soluble drug] Reduced body fat [increased fat soluble drugs] Reduced albumin {increased] M: Reduced P450 activity Reduced conjugation E: Reduced GFR and tubular secretion Bottom line: reduced age leads to greater and longer drug effects

Answer 100

Orally active= crosses placenta Implantation-\> abortion Embryonic-\> structural defets Fetogenic-\> relatvely less dangerous

Answer 101

ACEI: affect kidney growth AEDs: NTDs LI: Ebstein's anomaly Anti-folate e.g. trimeth-\> NTDs Tetracyclines-\> stains teeth Warfarin: cardiac defects, reduced IQ, saddle nose, blindness Statins

Answer 102

Asprin: haemorrhage, kernicterus Aminoglycosides: CN8 damage Anti-thyroid: goitre, hypothyroidism Benzos: floppy baby syndrome Chloramphenicol: grey baby syndrome Warfarin: haemorrhage Sulphonylureas: kernicterus

Answer 103

NB don't prescribe ACEI to fertile young women Labetalol Methyldopa Nifedipine Hydralazine

Answer 104

Poor glucose control associated with increased congenital abnormalities Use insulin and or metformin

Answer 105

Folic acid pre-conception Drug level tends to fall in pregnancy Increased risk of malformations Increased risk of haemorrhagic disease of newborn Avoid VPA Use LTG or CBZ

Answer 106

LMWH or warfarin

Answer 107

Drowsiness

Answer 108

Hypoglycaemia in infant

Answer 109

Digoxin Gentamicin Atenolol Amoxicillin Captopril

Answer 110

T1/2: 36-90 hours Low therpaeutic index, shoulde be monitored

Answer 111

Digoxin toxicity

Answer 112

T1/2:2.5-\> 50h MUST be monitored Increased risk of toxicity if reduced Na e.g. diuretics or dehydrated

Answer 113

Gentamicin

Answer 114

T1/2: 6-\>100hours

Answer 115

Asthma/bronchospasm Severe heart failure PVD

Answer 116

Atenolol toxicity

Answer 117

T1/2 2-\> 15hrs Toxcity: seizures (in meningitis, impaired BBB), rashes

Answer 118

Captopril toxicity

Answer 119

Alfacalcidol (1 alpha-hydoxylated)

Answer 120

Gentamicin Li Ciclosporin ACEI/ARB NSAIDs

Answer 121

Renal tubular damage-\> accumulation-\> increased nephro and ototoxcicity MUST monitor levels

Answer 122

Inhibits Mg-dependant enzymes e.g. adenylate cyclase ADH requires adenylate cyclase therefore Li causes nephrogenic DI Also causes direct tubular damage Must monitor drug levels

Answer 123

ADH requires adenylate cycle, an Mg-dependant enzyme inhibited by Li

Answer 124

Reduced GFR: reversible Damages renal tubules: irreversible P450 substrate Consider monitoring

Answer 125

Reduce GFR: inhibit efferent arteriolar vasoconstriction may be profound in RAS or CoA

Answer 126

Reduce GFR: prevent afferent arteriolar vasodilation Leading to papillary necrosis

Answer 127

Albumin levels Clotting factors synthesis Reduced FPM Reduce alpha 1 acidic glycoprotein Encephalopathy Hepatorenal syndrome

Answer 128

Increased proportion of free drug e.g. phenytoin, CBZ, predniosolne, diazepam, tolbutamide

Answer 129

Opiates Phenothiazine Imipramine

Answer 130

Chlorpromazine Quinidine Imipramine

Answer 131

Sedatives/opiates-\> coma Caution with drugs that may cause constipation Anxiolytis: temazepam safest due to short t1/2 TCAs safer but avoid MOAIs

Answer 132

Withdraw nephrotoxic drugs Modify doses of renally-excreted drugs

Answer 133

Clavulanic acid: may be delayed Fluclox: may be delayed Erythromycin Sulfonylureas OCP Tricyclics Chlorpromazine, prochlorperazine

Answer 134

Isoniazid Methyldopa

Answer 135

Paracetamol VPA, Phenytoin, CBZ Rifampicin, isoniazid, **pyrazinamide** Halothane Methotrexate Statins

Answer 136

Levonorgesterl 1.5mg PO STAT Ulipristal 30mg PO STAT

Answer 137

Act at bronchial B2 receptors: SM relaxation and reduce secretions

Answer 138

Tachycardia Tremor

Answer 139

Reduce K in high doses with corticosteroids, loop/thiazide diuretics/theophylline

Answer 140

Short acting, fast onset 2-4 hrs

Answer 141

Salbutamol (ventolin) Terbutaline (Bricanyl)

Answer 142

Bronchodilation Mucus secretion

Answer 143

Closed angle glaucoma Prostatic hypertrophy

Answer 144

3-6hrs Short acting

Answer 145

Ipratropium (Atrovent)

Answer 146

Tiotropium (Spiriva)

Answer 147

Beclometasone: Becotide Budenoside: Pulmicort Fluticasone: Flixotide

Answer 148

Budenoside and fomoterol

Answer 149

Salmeterol Formoterol

Answer 150

Fluticasone and salmeterol

Answer 151

Act over weeks to reduce inflammation: Reduce cytokine produciton Reduce prostaglanding/leukotriene synthesis Reduce IgE secretion Reduce leukocyte recruitment Prevent long term decline in lung function

Answer 152

Oral candidiasis High doses may lead to typical steroid SEs

Answer 153

2x as potent: use lower dose

Answer 154

Can be used as a preventer or a reliver because of formoterol's fast onset

Answer 155

Use a spacer Rinse mouth after use

Answer 156

Methylxanthines

Answer 157

PDE inhibitors: increase cAMP-\> bronchodilation

Answer 158

Nausea Arrhythmias Seizures Hypokalaemia

Answer 159

Smoking EtOH CYP inducers

Answer 160

CCBs CYP inhibitors

Answer 161

Aminophylline is IV form: give IVI slowly Too fast -\> VT Monitor with ECG and check plasma levels CYP metabolism NB if pt already on theophylline cannot have IV aminophylline

Answer 162

Leukotreine receptor antagonists Block cysteinyl leukotrienes

Answer 163

?Churg Strauss

Answer 164

NSAID and exercise induced asthma

Answer 165

Severe immunological disease

Answer 166

Humanised anti-IgE mAb

Answer 167

SC injection every 2-4w Used for severe asthma

Answer 168

GI bleed (rare)

Answer 169

Active peptic ulceration

Answer 170

Mucolytic CF

Answer 171

Certrizine Loratidine Fexofenadine

Answer 172

Chlorphenamine

Answer 173

In the field of pharmacology, an inverse agonist is an agent that binds to the same receptor as an agonist but induces a pharmacological response opposite to thatagonist. A neutral antagonist has no activity in the absence of an agonist or inverse agonistbut can block the activity of either

Answer 174

hypotension Arrhythmia: long QT Older agents: drowsiness Anti-AChM

Answer 175

Severe hepatic disease

Answer 176

Long QT BPH Closed-angle glaucoma

Answer 177

Does not cross the placenta

Answer 178

Candidiasis Hypokalaemia

Answer 179

Must remember to stop it due to risk of osteoporosis

Answer 180

Thiazide like diuretic

Answer 181

Indapamide- will cause sodium loss-\> hyponatraemia Citalopram-\> SIADH (obscure adverse effect) Periondopril will cause hyponatraemia but hyperkalaemia

Answer 182

Because cholesterol synthesis is thought to happen prinicipally during the night

Answer 183

grams in 100 millilitres gives you the percentage

Answer 184

millilitres in 100 millllitres

Answer 185

2b3a antagonist

Answer 186

Dose independent

Answer 187

Recommended in patients with HF as unlikely to make HF worse. Diclofenac should not be used as it has a high risk of cardiovascular events

Answer 188

1mg per ml

Answer 189

0.1mg per ml

Answer 190

Procyclidine 5mg IM

Answer 191

200mg/24 hours

Answer 192

Thiazide diuretics: increase Na clearance at the expense of uric acid excretion

Answer 193

N+V Furred tongue Metallic taste in mouth

Answer 194

IV and PO both same onset of action If plan is to restart warfarin, give IV as PO action takes longer to turn off than IV

Answer 195

Aminoglycosides Vancomycin Lithium

Answer 196

Aminoglycosides Vancomycin Lithium Digoxin Phenytoin

Answer 197

Technically not as it is not the [plasma] being monitored, rather the biological effect

Answer 198

Excreted unchanged by the kidney e.g. furosemide Phase 1 metabolism-\> kidney or phase 2 Phase 2 metabolism: undergoes phase 2 transformation and then excreted

Answer 199

Oxidation Reduction Hydrolysis Molecule itself is directly altered usually by cytochrome p450 (oxidation)

Answer 200

Either the original drug or its modified form is then conjugated e.g. glucuronidation, sulphation, acetylation This tends to make compound more polar, allowing excretion more readily

Answer 201

CYP3A4: accounts for 30% of prescribed drugs e.g. CCBs, statins, BZDs

Answer 202

Next most important cytochrome, metabolises 20% of drugs e.g. antidepressants, beta blockers, some opiates

Answer 203

Paracetamol Caffeine Theophylline

Answer 204

Warfarin Ibuprofen

Answer 205

Diazepam Omeprazole

Answer 206

Prodrug, ACEi converted to enlaprilat

Answer 207

Prodrug, converted to 6-mercaptopurine

Answer 208

Ez-glucuorine Converted to the glucuronide in the liver which is the active form. This reaches the lumen of the small intestine where it blocks cholesterol absorption

Answer 209

The study of genetically determined varaitions in the response to drugs

Answer 210

A small number of drugs are metabolised by acetylation, there are fast and slow acetylators, which is genetically determined and which may have different side-effects Drugs that udnergo acetylation include isoniazid, hydralazine, dapsone

Answer 211

Pseudocholinesterase G6PD Porphyria

Answer 212

Patients lacking this enzyme had prolonged recovery after anaesthesia

Answer 213

Predictable reactions Common Dose-related but can occur at therapeutic doses Consequence of known pharmacology of drugs

Answer 214

Idiosyncratic reactions Rare to very rare Usually not dose related Include true allergies Include some pharmacogenetic variations

Answer 215

Dependence/addiciton e.g benzos Withdrawal phenomena inc rebound e/g/ clonidine Adaptive changes e.g. typical antipsychotics-\> tardive dyskinesia

Answer 216

Carcinogenesis Teratogenesis

Answer 217

Augmented pharmacological effect Bizarre Chronic Delayed End of treatment

Answer 218

Pharmacodynamics: pharmacokinetic properties e.g. digoxin Dose e.g. beta blockers Formulation e.g. digoxin ROA e.g. phenytoin Rate of administration e.g. aminophylline

Answer 219

Oral- rarely CV problems IV: bradycardia/hypotension

Answer 220

Given too quickly-\> ventricular arrythmia

Answer 221

Increases risk of hepatic encephalopathy and worsening liver failure

Answer 222

Non-immune mechanisms, pharmacolgoical e.g. salicylates, other NSAIDs-\> bronchospasm. shift metabolsim from prostaglandins to leukotrienes which leads to bronchospasm ACEi-\> cough, angioedema (anaphylactide)

Answer 223

Penicllins, contrast media, opiates

Answer 224

Penicllins, sulfonamides

Answer 225

Sulfonamides, OCP

Answer 226

Amiodarone Thiazides Sulfonylureas

Answer 227

Erythromycin Sulfonamides et.c

Answer 228

Penicllins, isoniazid, hydralazine

Answer 229

Drug causes rash in a fixed distribution Drug stopped, if restarted rash appears in same distribution

Answer 230

Phenothiazines (formerly used as an antihelminthic) TCA Sulfonylurea Erythromycin Clavulanic acid (may be delayeed) Carbimazole Anabolic steroids (dose related)

Answer 231

Isoniazid Pyrazinamide Methyldopa TCA Phenytoin All of the above can occur from acute or chronic use Pracetamol (dose dependant) Methotrexate (dose dependant) (causes liver fibrosis)

Answer 232

Isoniazid Methyldopa

Answer 233

Fibrates Oestrogens

Answer 234

Cytotoxics (Type A) Type B: Chloramphenicol( (1/10000, tends to be lethal) Phenytoin Peniclliamine Phenothiazines

Answer 235

All type B Carbamazepine Carbimazole Clozapine Mianserin- withdrawn Sulfasalazine

Answer 236

It is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA)

Answer 237

All type B Chloroquine Captopril Quinidine Salicylates VPA (most important)

Answer 238

Amiodarone Nitrofurantoin Penicillamine Isoniazid Dose dependant: Vincristine Cis-platin

Answer 239

B-Bleomycin B-Busulfan C-Cyclophosphamide M-Methylsergide A-Amiodarone N-Nitrofurantoin Methotrexate

Answer 240

Azathioprine is a purine analogue that interferes with DNA synthesis and inhibits the proliferation of quickly growing cells, especially cells of the immune system. It is used as an immunosuppressant in patients undergoing organ transplantation, and its metabolite 6-mercaptopurine is used in the treatment of autoimmune diseases and acute lymphoblastic leukemia. During metabolism, hypoxanthine-guanine phosphoribosyltransferase (HGPRT) converts 6-mercaptopurine to cytotoxic 6-thioguanine nucleotide analogues, while thiopurine methyltransferase (TPMT) inactivates 6-mercaptopurine through methylation to form 6-methylmercaptopurine. Approximately 11% of the population has reduced TPMT activity and 0.3% of the population has true deficiency of TPMT. [1] In these patients, active 6-mercaptopurine accumulates, and a larger proportion of 6-mercaptopurine is converted to the cytotoxic 6-thioguanine nucleotide analogues, which can lead to bone marrow toxicity and myelosuppression

Answer 241

Opiates BZDs Corticosteroids

Answer 242

Clonidine Beta-blcokers Corticosteroids

Answer 243

Endometrial ca ?breast ca

Answer 244

Phase 1: normal volunteers (50) Phase 2: patients, open study (200) Phase 3: clinical trials: DB-RCT Phase 4: post marketing

Answer 245

Post-marketing: yellow card Cohort studies Prescription event monitoring

Answer 246

Newly licensed usually \<2y Report any suspected adverse reaction

Answer 247

Only report serious adverse reactions: fatal, life-threatneing, needing hospital admission, disabling

Answer 248

Ones taking place outside the body Generally IV drugs being mixed together e.g. Ca and bicarbonate precipitating out Always read instruction

Answer 249

Tetracyclines, quinolones + Ca, Fe, Al Altered absorption if given with any metal due to chelation Think about drug timing

Answer 250

Warfarin + NSAIDs

Answer 251

Sodium VPA Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol- binge drinking Chloramphenicol Erythromycin and other macrolides Sulfonamides Ciprofloxacin Omeprazole Metronidazole Grapefruit juice

Answer 252

Makes it more cyotoxic

Answer 253

MAOI and cheese-\> hypertensive reaction. e.g. cheese, marmites (foods containing tyramine)

Answer 254

Carbamezapine Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbitone Sulphonylureas

Answer 255

Increased Na clearance but decreased Li clearance

Answer 256

Inihbit each others excretion and increase toxicitiy, particularly ototoxicity

Answer 257

Diuretics, corticosteroids + digoxin (low K) NSAIDs and warfarin: damage to stomach, increased risk of GI bleed Antibiotics and warfarin. reduced gut bacteria (involved in K production)

Answer 258

Drugs that are eliminated by the kidney Drugs that are metabolised by the kidney Nephrotoxic drugs

Answer 259

DIgoxin Gentamicin Atenolol Amxocivillin Captopril

Answer 260

Gentamicin

Answer 261

Generally nontoxic In patients with renal impairment the half life of the drug is substantially increased( 14h) In patients with menigitis, the BBB is disrupted and this allows amoxiillin to accumulate in the CSF These patients may develop seizures. The allergic manifestation of drugs may also appear more commonly in this group of patients

Answer 262

Vit D3 (cholecalciferol- formed in skin). Vit D (made by uv irradiation of ergosterol) Both forms are activated sequentially. 25a in liver 1a in the kiney to yield 1,25 di(OH)D3 and 1,25 di(OH)D2

Answer 263

Hypocalcaemia with relative conseuqence of hypophosphataemia lead to hyperparathyroid Consequnece of failure in VtiD/ renal pathway

Answer 264

Renal tubular damge Important in that damage occus with an accompanying degree of reduciton in GFR leading to gentamicin accumulation. Causes a cycle. Importance of appropriate gentamicin TDM

Answer 265

Nephrogenic DI: through inhibiting Mg dependent enzymes (adenylate cyclase) which is activated in renal tubule by ADH. and Tubular damage

Answer 266

Reduced GFR and Tubular function Used in renal transplant immunosuppression. Physician needs to distinguish between rejection episode causing decline in renal function or cyclosporin toxicity.

Answer 267

TDM Hypertension Reduced GFR

Answer 268

A2Rs located principally on the efferent arteriole. Have a vasoconstrictive effect. If you administer ACEi which blocks biosynthesis of AngII or you give ARB there will be dilatation of the efferent arteriole. As a consequent of that, renal blood flow through glomerulus increases. However, the pressure within the glomerular tuft decreases. The GFR is dependent on the perfusion pressure within the glomerular tuft, as perfusion pressure reduces, GFR reduces. If a patient has a pathological reduction in pressure in the afferent arteriole e.g. RAS,(or more rarely in CoARc sited proximally to the renal arteries) there is a danger that if you inhibit ACEI/ARB for the pressure within glomerular tuft to reach pathologically low levels with a consequent critical reduction in GFR.

Answer 269

Inhibit COX and reduce PG concentration. In the kidney and renal vasculature, most of the PGs are vasodilator. Effects are mediated by prostaglandin E2 and prostacycline. These molecules regulate the diameter of blood vessels around the glomerulus. LT use of NSAIDs. particularly in patients with preexisting renal damage, may result in a further reduciton in GFR and Na retention. May also cause papillary necrosis. Papilla receives blood supply from surrounding bvs that require PGs to maintain their diameter, thus patients receiving high concentrations of NSAIDs may develop relative ischaemia of the renal papilla-\> necrosis if sustained. Necrotic papilla may become detached from renal cortex, fall into renal pelvis and block ureturs

Answer 270

Albumin: hypoalbuminaemia may increase proportion of the free drug, more of a problem if drug clearance is reduced. e.g. Diazepam, tolbutamide, phenytoin A1-acidic glyocoprotein: binds basic drugs e.g. quinidine, chlorpromazine and imipramine Reduced synthesis of Clotting factors Warfarin and synthesis of Vit-K dependant clotting factors

Answer 271

2, 7, 9, 10

Answer 272

Opiates (most important): prolonged elimination, may precipitate encephalopathy Anti-psychotics: phenothiazine and butyrophenones Anxiolytes and hyponotics: oxazepam and temazepam are safest Antidepressants: TCAs are safest, avoid MAOs: idiosyncractic hepatotoxicity

Answer 273

Opiates Major tranquilisers etc.

Answer 274

?hepatorenal syndrome R/v drug chart and withdraw drugs that may be contributing

Answer 275

Those with high FPM High plasma protein binding Low TI Those with CNS depressant effect

Answer 276

Normally only a small proportion of ingested blood enters blood, liver disease-\> very reduced FPM e.g. Clormethiazole Chlorpromazine Imipramine Morphine Pethidine

Answer 277

Combination of high protein binding and reduced elmination likely to precipitate a prolbem e.g. Chloral hydrate Phenytoin

Answer 278

Any incapacity of liver to metabolise drug and reduce toxic levels likely to precipiate toxicity e.g. barbiturates

Answer 279

Principally because of capacity to control through autonomic NS the important CV and respiratory functions likely to become hypotensive, develop bradycardias and stop breathing. Drugs include opiates, phenothiazine and othrers with known sedative effects

Answer 280

Non-covalent or Covalent

Answer 281

Occur as a consequence of the activity of cytochrome p450. During these reaction oxygen radicals can be generated e.g. peroxides, superoxides, hydroxyl radicals. Highly reactive molecular species that may damage the structure of lipids, aas and other molecules. Normally glutathione is there to protect the cell and serves as free radical scavenger, however in established liver disease glutathione may become depleted and this may increase the propensity of oxudative products to cause issues

Answer 282

Involve adduct formation between drug/metabolite and DNA/proteins/lipids within the cell

Answer 283

Hepatocellular necrosis: Paracetamol- reactive intermediate Halothane: repeated use Anticonvulsants Carbamazepine, phenytoin and valproate MAOIs, isoniazid, nitrofurantoin, sulphonamides Hydralazine, methyl dopa Cholestasis: Chlorpromazine Sulphonylureas (glibenclamide) Carbimazole

Answer 284

Ciprofloxacin

Answer 285

Penicillin

Answer 286

Azathioprine

Answer 287

Theophylline

Answer 288

Clopidogrel

Answer 289

Penicillamine

Answer 290

Methyldopa

Answer 291

Amitryptilline

Answer 292

Bendroflumethiazide

Answer 293

Rifmapicin

Answer 294

Cimetidine

Answer 295

Longer acting insulin that binds to albumin in the circulation

Answer 296

Longer acting aa-altered insulin, thus prolonged absorption from subcutaneous tissue

Answer 297

Switches off hepatic glucose output: gylcogenolysis gluconeogensis Inhibits ketogenesis

Answer 298

Increaes lipoprotein lipase activity: reduces hypertriglyceridaemia Increases GLUT4 activity-\> glucose stored as fat Decreased lipolysis: reduced [glycerol], [non-esterified fatty acids reduced]

Answer 299

Decreased proteolysis: decreased aa delivery to liver for gluconeogenesis Increased GLUT4 activity-\> [reduced glucose]

Answer 300

Short t1/2 of IV insulin means bolus is never useful. Should be given by infusion

Answer 301

Short acting with breakfast Second dose with lunch Third with evening meal Intermediate insulin given OD ACTrapid given 15 mins before meal Intermediate given before patient goes to bed

Answer 302

Doesn't tell you how much insulin is needed Post prandial tell you how much you should have given

Answer 303

Tells us how much long acting needs to have been given night before

Answer 304

Human insulin. Forms hexamers under skin and is abosrbed over 3-4h Needs to be given 15 mins before meal Can lead to late post prandial hypoglycaemia Can lead to immediate post-prandial hyperglycaemia that may lead to diabets cx

Answer 305

Short acting insulin that has modified aa so doesn't form hexamers under skin Faster onset and shorter duration of action Can be given at beginning of food or even after food.

Answer 306

Long acting insulin + sulphonylurea BD mixtrrd Full basal bolus Insulin + metformin

Answer 307

Didn't gain weight that is seen in intensive insulin alone

Answer 308

May not be as effective as EtOH uses glycogen in metabolism

Answer 309

Control total calories/increase exercise Reduced refined carbohydrate Increase complex carbohydrate as a proportion of carbohydra Reduce fat as proportion of caloires Increase unsaturated fat as a proprotion of fat Increase soluble fibre Address Na intake

Answer 310

Insulin sensitiser Biguanide Increases hepatic insulin sensitivity Inhibits hepatic gluconeogenesis

Answer 311

GI disturbance: nausea and diarrhoea Lactic acidosis (rare) Do not use if severe liver, severe cardiac, or mild renal failure (elevated Cr + radiological contrast media)

Answer 312

Sulphonylureas Metaglinides

Answer 313

Act on insulin secretagogue Act on beta cell to acutely cause insulin release independent of glucose concentration Stimulate second phase insulin secretion

Answer 314

Hypoglycaemia: can be severe, prolonged, or even fatal Especially a problem in elderly, alcoholics and those with poor nutirtion- not enough stored glyocgen Weight gain Rarer complications: rashes, blood dyscrasia

Answer 315

Sulphonylureas

Answer 316

Repaglanide Nataglinide

Answer 317

Sulphonylureas

Answer 318

Reduce lipotoxicity Increase muscle insulin sensitivity Favourable fat distribution Suppression off fatty acid release through PPARg agonism

Answer 319

Thiazolidinediones

Answer 320

Glitazone: PPARg agonists

Answer 321

Act on intranuclear PPARg Adipose tissue\>liver and muscle Affect lipoprotein lipase, FA transporter, CoA synthase, GLUT4 Insulin resistance reduced

Answer 322

PPARg agonist e.g. glitazone

Answer 323

Peripheral weight gain Oedema Should not be used with insulin

Answer 324

Delay oligosaccharide absorption

Answer 325

Flatulence

Answer 326

Inhibit glucagon release Cause acute insulin release Stimulate insulin biosynthesis Improve beta cell differentiation

Answer 327

Slow gastric eptying Inhibit glucagon release Cause acute insulin release

Answer 328

Can exacerbate pre-existing ischaemic heart disease

Answer 329

Osteopenia/osteoporosis AF (especially in older patients) Should not aim to suppress TSH, should aim to bring it within normal range

Answer 330

Use beta blockers as thionamides won't work

Answer 331

Warn patient to stop due to risk of agranulocytosis

Answer 332

Opthalmopathy/tracheal compression

Answer 333

Antacid Neutralises gastric acid

Answer 334

Antacid Neutralises gastric acid

Answer 335

Alginate Reduces reflux: increased stomach content viscosity Forms a raft on top of stomach contents

Answer 336

PPIs Activated in acidic pH Irreversibly inhibit H/K ATPase More effective than H2R antagonsits

Answer 337

H2 R antagonists Reduce gastric parietal cell H secretion

Answer 338

Prostaglandin analgoue Acts on parietal cells to reduce secretion

Answer 339

Constipation

Answer 340

GI distrubance Headache

Answer 341

Mainly with cimetidine: GI disurbance

Answer 342

Diarrhoea is very common

Answer 343

Interfere with drug absorption- take separately

Answer 344

Interfere with drug absorption- take separately

Answer 345

P450 inhibitor

Answer 346

P450 inhibitor

Answer 347

Take when symptoms occur/expected

Answer 348

Masy mask symptoms of gastric carcinoma

Answer 349

May mask symptoms of gastric Ca

Answer 350

Mainly used to prevent NSAID-associated PUD Often in combination with NSAID e.g. diclogenac + misoprostol= arthrotec

Answer 351

Bulk laxatives Increase feacal mass-\> increased peristalsis

Answer 352

Stimulant laxatives Increase intestinal motility

Answer 353

Osmotic laxatives Increse stool water content

Answer 354

Stool softener

Answer 355

Reduced ADEK absorption Granulomatous reactions

Answer 356

Bowel obstruction

Answer 357

A mild stimulant laxative used in Rx of opioid induced constipation

Answer 358

Antimuscarinic- antispasmodic

Answer 359

Antispasmodic

Answer 360

Opioid receptor agonist Doesn't cross BBB therefore no central effects

Answer 361

5-ASA Unknown MOA

Answer 362

Steroid More potent than prednisolone High FPM therefore less systemic effects

Answer 363

Chimeric anti-TNF mAB

Answer 364

P75 TNFRFc fusion protein

Answer 365

Human anti-TNF mAb

Answer 366

Anti-AChM SEs: dry mouth, palpitations

Answer 367

Abdo cramps

Answer 368

Sulfasalzine has increased SEs: blood dyscrasias hepatitis rash, urticaria Oligospermia pulmonary fibrosis

Answer 369

Severe infections TB Allergic reactions CCF CNS demyelination

Answer 370

Monitor FBC Topical in distal disease

Answer 371

Use to induce remission in ileal crohn's

Answer 372

Screen for TB before parenteral admin Give hydrocortisone to reduce allergic SEs

Answer 373

Salbutamol Terbutaline

Answer 374

Salmeterol Formoterol

Answer 375

Act @ bronchial B2 receptors- smooth muscle relaxation reduced mucus secretion

Answer 376

Bronchodilation Mucus secretion

Answer 377

Ipratropium

Answer 378

Tiotropium

Answer 379

Beclometasone Budesonide Fluticasone

Answer 380

Budesonide + formoterol

Answer 381

Fluticasone + salmeterol

Answer 382

Act over weeks to reduce inflammation Reduce cytokine production Reduce prostaglanding/leukotriene synthesis Reduce IgE secretion Reduce leukocyte recrutiement Prevent long term decline in lung function

Answer 383

Methylxanthines PDE inhibitors: increse cAMP-\> bronchodilation

Answer 384

Leukotriene antagonists Block cysteinyl leukotirenes

Answer 385

PDE4 inhibitor

Answer 386

Humanised anti-IgE mAb

Answer 387

DNAse (mucolytic)

Answer 388

Selective H1R inverse agonists aka H1 antagonists

Answer 389

Certirizine Des/ loratidine Feoxfenadine

Answer 390

Chlorphenamine

Answer 391

Hypotension Arrhthmia: long QT Older agents: drowsiness Anti-AChM

Answer 392

GI bleed (rare)

Answer 393

?Churg-Strauss

Answer 394

Nausea Arrhythmias Seizures Hypokalaemia

Answer 395

Oral candidiasis High doses may -\> typical steroid SEs

Answer 396

Tachycardia Tremor

Answer 397

Closed angle glaucoma Prostatic hypertrophy

Answer 398

Severe immunological disease

Answer 399

Active peptic ulceration

Answer 400

Severe hepatic disease Caution: long QT BPH Closed angle glaucoma

Answer 401

Reduced levels: smoking, EtOH, CyP inducers Increased levels: CCBs CyP inhibitors

Answer 402

Reduced K in high doses with corticosteroids, loop/thiazide diuretics Theophylline

Answer 403

Can be given IV in acute severe asthma

Answer 404

Decreases risk of complications: use spacer, rinse mouth after use Fluticasone is 2x as potent so use at lower dose Symbicort can be used as a reliever or a preventer because of formoterol's fast onset

Answer 405

Aminophylline is IV form Give IVI slowly, too fast-\> VT Monitor with ECG and check plasma levels

Answer 406

Particularly useful for NSAID and exercise induced asthma

Answer 407

SC injection every 2-4w Used for severe asthma

Answer 408

500mg TDS PO

Answer 409

500mg BD PO

Answer 410

200mg BD PO

Answer 411

1.2g TDS IV

Answer 412

20mg OD Nocte PO

Answer 413

20mg OD PO

Answer 414

10mg OD PO

Answer 415

2.5mg OD PO

Answer 416

1.25mg OD PO

Answer 417

30mg every 4h PRN PO Max 240mg daily

Answer 418

50mg ever 4h PRN PO Ma 300mg daily

Answer 419

Treatment: 1.5mg/kg/24h SC Prophlyaxis: 40mg OD SC

Answer 420

Alkylates DNA Affects B cells\> T cells

Answer 421

Alkylates DNA

Answer 422

Blocks de novo nucleotdie synthesis Affects T cells \> B cells

Answer 423

Blocks de novo nucleotide synthesis Affects T cells \> B cells

Answer 424

Dihydrofolate reductase inhibitor

Answer 425

Alkylates DNA

Answer 426

Cyclophosphamide Cispaltin Azathioprine Mycophenolate mofetil Methotrexate Chlorambucil

Answer 427

Ciclosporin Tacrolimus Sirolums

Answer 428

Calcineruin inhibitors Block IL-2 production

Answer 429

Blocks mTOR pathway

Answer 430

Murnomab-CD3 Basiliximab Toilizumab Abatecept

Answer 431

Blocks CD3 on T cells

Answer 432

Blocks CD25R (alpha chain of Il-2R)

Answer 433

Blocks IL-6 R

Answer 434

Anti CTLA-4 Ig Blocks costimulation of T cells

Answer 435

Inhibits phosophilapse A2: Reduces platelet activating factor Reduced arachidonic acid Reduced trafficlking of phagocytes (hence transient increase in phagocyte count) Lymphopenia, apoptosis of T+V cells

Answer 436

Binds to p40 subunit of IL-12 and IL-23

Answer 437

Anti-CD20 Redcues B cells (not plasma cells) used for lymphoma and autoimmune disease

Answer 438

Binds to CD-52 Used in CLL

Answer 439

Anti-a4 integrin Used in MS and Crohn's

Answer 440

Bm suppresswion Haemorrhagic cystitis Alopecia Sterility

Answer 441

BM suppression Severe n/v Nephrotoxic Ototoxic Peripheral neuropathy

Answer 442

Bm suppression Hepatotoxicity n/v/d Arthralgia

Answer 443

BM suppression Skin malignancy GI upset

Answer 444

Pulmonary fiboris Hepatotoxic Mucositis

Answer 445

BM suppression EM-\> SJS

Answer 446

Nephrotoxic Hepatic dysfunction Tremor Hypertrichosis Gingival hypertrophy Encephalopathy

Answer 447

Nephrotoxic \< cf ciclosporin Diabetogneic Neurotoxic \> cf ciclopsoinr

Answer 448

Dyslipidaemia

Answer 449

Diabetes Central obesity Adrenal suppression Cataracts Glaucoma Pancreatitis Osteopororis Cushingoid Hirstutism Neutrophilia

Answer 450

Allopurinol-\> increased toxicity

Answer 451

Increased toxicity with NSAIDs, ciclosporin, Crohn's

Answer 452

P450 inhibitors

Answer 453

Cancer RA SLE Systemic sclerois Wegener's

Answer 454

Prevent Tx rejection Steroid sparing agent: IBD, SLE, RA

Answer 455

Prevent Tx rejection AI disease

Answer 456

Cancer RA Psoriasis Crohn's

Answer 457

Cancer e.g. CLL

Answer 458

Prevent Tx rejection GvHD UC RA Psoriasis

Answer 459

Prevent Tx rejection

Answer 460

Give mensa to prevent haemorrhagic cystitis Activated by p450

Answer 461

Carboplatin is associated with less severe SEs Requires pre-admin hydration

Answer 462

Do TPMT assay before use 50% of patients intolerant of azathioprine tolerate 6-MP

Answer 463

Give folinic acid to reduce risk of myelosuppression Monitor U+E, FBC, LFT

Answer 464

Monitor LFTs

Answer 465

Aklyating agents Antimetabolites Cytotoxic Abx Microtubule inhibitors Topoisomerase inhibitors Immune modulators MAbs Tyrosine kinase inhibitors Endocrine modulators

Answer 466

Cyclophosphamide Chlorambucil Busulfan Cisplatin

Answer 467

DNA x-linking Base mis pairing Excision of alkylated DNA-\> strand breaks

Answer 468

Methotrexate 5-FU

Answer 469

Anthracycline: doxorubicin, daunorubicin Bleomycin

Answer 470

Intercalate with DNA Free radical formation

Answer 471

Vinca alklaoids: vincristine, vinblastine Taxanes: paclitaxel

Answer 472

Thalidomide, lenalidomide

Answer 473

Anti-Her 2: breast Ca

Answer 474

Anti-EGFR (CRC)

Answer 475

Anti-CD20 NHL

Answer 476

Erlotonib Imatinib Sinitimib

Answer 477

N/v: prophylactic anti-emetics Alopecia Neutropenia: 10-14d post chemo Extravasation of chemo agents: pain, burning brusing at infusion site. Stop infusion, give steroids, apply cold pack. Liaise early with plastics Hyperuricaemia Oral mucositis

Answer 478

Haemorrhagic cystitis: give mensa Hair loss BM suppression

Answer 479

Cardiomyopathy Extravasation reactions

Answer 480

Pulmonary fibrosis

Answer 481

Peripheral neuropathy Don't give intrathecal

Answer 482

Peripheral neuropathy Hypersensitivity Pre rx with anti-histamines and steroids

Answer 483

Palmar-plantar erythrodysthesia Mucositis

Answer 484

Low risk: domperidone/metoclopramide started pre Rx High risk: ondanestron + dex + aprepitant

Answer 485

5- FU Epirubicine Cyclophospamide

Answer 486

Cyclophosphamide Methotrexate 5-FU

Answer 487

Bleomycin Etoposide cisPlatin

Answer 488

Carboplatin Pacliatzel

Answer 489

NHL Ritxuimab Cyclophosphamide Hydroxydaunomycin (doxorubicin) Oncovin Pred

Answer 490

HL Adriamycin Bleomycine Vinblastine Dacarbazine

Answer 491

Don't stop steroids suddenly Consult doctor when unwell Increase does with illness or stress Carry steroid card Avoid OTcs e.g. NSAID Osteoporosis and PUD prophylaxis (Ca+ vit D, bisphosphonates, PPI)

Answer 492

GI: Candidiasis, PUD, oesophageal ulceration, pancreastitis Cardio: HTN, CCF MSK: Proximal myopathy Osteoporosis Endo: Growth suppression, HPA suppression, Cushing's Metabolic: Na and fluid retention Raised PMN Reduced K CNS: Depression, psychosis Eye: Cataracts, glaucoma Immune: Increased susceptibility to infection

Answer 493

Tacrolimus Azathioprine Pred: withdraw at 3m

Answer 494

Pre-op: Alemtuzumab Post op Pred Tacrolimus LT

Answer 495

5-ASAs Methotrexate Hydroxychloroquine Penicllamine Infliximab

Answer 496

Reduced activation of dendritic cells

Answer 497

Colchcine Allopurinol Feboxustat Probenecid Rasburicase

Answer 498

XO inhibitor

Answer 499

XO inhibitor

Answer 500

Urcisouric

Answer 501

Recombinant uric oxidase

Answer 502

Non-selective COX inhibitors Analgesic Antipyretic Anti-inflammatory

Answer 503

Selective COX2 I

Answer 504

Ibuprofen Diclofenac Aspirin Naproxen Indomethacin Ketoprofen

Answer 505

Stigmines Baclofen Dantrolene

Answer 506

Anticholinesterases: Increase ACh in the synpatic cleft Enhacne neuromuscular transmission

Answer 507

GABA agonist Skeletal muscle relaxant

Answer 508

Prevents Ca release from sarcoplasmic reticulum Skeletal muscle relaxant

Answer 509

Visual change: rarely retinopathy Seizures BM suppression

Answer 510

Nephrotic syndrome Drug-induced lupus Taste change

Answer 511

Severe infectsion TB Allergic reactions CCF CNS demyelination Increased AI disease and C

Answer 512

Diarrhoea Renal impairment

Answer 513

Severe skin reactions -\> SJS GI upset Hepatotoxic

Answer 514

Headache Rash Abnormal LFTs

Answer 515

Gastritis and PUD Reduced GFR Interstitial nephritis Papillary necrosis hyperkalaemia Peripheral oedema Bronchospasm EM-\> SJS

Answer 516

Cholinergic

Answer 517

Sedation Reduced tone Nausea Urinary distrubance

Answer 518

Hepatotoxicity GI upset

Answer 519

Caution in G6PDD

Answer 520

Caution in renal impairment

Answer 521

Caution in R + L: reducce dose

Answer 522

R+L disease

Answer 523

R+L disease

Answer 524

Renal or cardiac failure PUD Severe hepatic impairment Caution in: the elderly, asthma

Answer 525

IHD Cerebrovascular disease L+R disease

Answer 526

Asthma Inestinal/urinary obstruction

Answer 527

Hepatic impairment

Answer 528

Reduces metabolism of azathioprine: avoid

Answer 529

Increased bleeding with warfarin Reduces effects of ACEi and ARBs Increases toxicity of methotrexate

Answer 530

Reduces effects of ACEis and ARBs Increases toxicity of methotrexate

Answer 531

Increased by TCAs

Answer 532

Monitor vision

Answer 533

Chelates Cu and Pb Prevents stones in cystinruia

Answer 534

Initial Rx can increase gout Initiate with NSAID/colchicine cover

Answer 535

Can be given with other agents for gastroprotection: PPI, H2Ras, misoprostol

Answer 536

Assess CV risk before use Only used for short periods in young patients with intolerance for other NSAIDs

Answer 537

Edrophonium preferred for Dx of MG Pyridostigmine preferred for the Rx of MG (long t1/2)

Answer 538

Used to relieve chronic spasiticity and malignant hyperthermia

Answer 539

Viagra? - contraindicated by nitrates and nicorandil Patients taking nitrates cannot take sildenafil concurrently as this may potentiate the vasodilating effects of such drugs

Answer 540

Patients taking nitrates and related drugs such as nicorandil Hypotension Recent stroke or MI (NICE recommend waiting 6 months)

Answer 541

Visual disturbances e.g. blue discolouration, non-arteritis anterior ischaemic neuropathy Nasal congestion Flushing GI side-effects Headache

Answer 542

Patients who have had an acute MI and who have symptoms and or signs of heart failure and left ventricular systolic dysfunction should be treated with an aldosterone antagonist licensed for post-MI therapy e.g. eplerenone 3-14d post MI, preferrably after ACEI therapy

Answer 543

Pregnancy Prolactinoma Physioloical PCOS Primary hypothyroidism Phenothiazines, metocloPramide, domPeridone (oestrogens, acromegaly)

Answer 544

Metoclopramide, domperidone Phenothiazines Haloperiodl SSRIs, opioids

Answer 545

Statins ACEi Amiodarone

Answer 546

LFTs at baseline, 3m, 12m

Answer 547

U+E, Prior to treatment After increasing dose at least annually

Answer 548

TFT, LFT TFT, LFT, U+E, CXR prior to treatment TFT, LFT every 6m

Answer 549

Methotrexate Azathioprine

Answer 550

FBC, LFT, U+E The Committee on Safety of Medicines recommend 'FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months'

Answer 551

FBC, LFT FBC, LFT before treatment FBC weekly for the first 4 weeks FBC, LFT every 3 months

Answer 552

Lithium LFT

Answer 553

Lithium level, TFT, U&E TFT, U&E prior to treatment Lithium levels weekly until stabilised then every 3 months TFT, U&E every 6 months

Answer 554

LFT LFT, FBC before treatment LFT 'periodically' during first 6 months

Answer 555

LFT before treatment LFT 'regularly' during treatment

Answer 556

Amiodarone Cytotoxic agents: busulphan, bleomycin Anti-rheumatoid drugs: methotrexate, sulfasalazine, gold Nitrofurantoin Ergot-derived dopamine R antagonists: bromocriptine, cabergoline, pergolide

Answer 557

Decongestants e.g. phenylephrine/oxymetazoline

Answer 558

Topical briminodine in glaucoma

Answer 559

BPH e.g. tamsulosin HTN e.g. doxazosin

Answer 560

Inotropes e.g. dobutamine

Answer 561

Bronchodilators e.g. salbutamol

Answer 562

PD e.g. ropinirole Prolactinoma

Answer 563

BZD Baclofen

Answer 564

Glaucoma e.g. pilocarpine

Answer 565

Nicotine Varenicline (uesd for smoking cessation) Depolarising muscle relaxant e.g. suxamethonium

Answer 566

Inducing labour e.g. syntocinon

Answer 567

Triptans e.g. for acute migraine (zolmitriptan)

Answer 568

Non-selective and selective e.g. atenolol and bisoprolol

Answer 569

Non-selective beta-blockers e.g. propranolol, labetalol

Answer 570

Schizophrenia e.g. haloperidol Anti-emetics e.g.s metoclopramide/domperidone

Answer 571

Flumezanil

Answer 572

Antihistamines e.g. loratidine

Answer 573

Atropine e.g. for bradycardia Bronchodilator e.g. ipratropium bromide, tiotropium Urge incontinence e.g. oxybutynin

Answer 574

Non-depolarising muscle relaxants e.g. atracruium

Answer 575

Tocolysis e.g. atosiban

Answer 576

Anti-emetics e.g. ondansetron

Answer 577

Loop diuretics Furosemide and bumetanide are loop diuretics that act by inhibiting the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl. There are two variants of NKCC; loop diuretics act on NKCC2, which is more prevalent in the kidneys.

Answer 578

heart failure: both acute (usually intravenously) and chronic (usually orally) resistant hypertension, particularly in patients with renal impairment

Answer 579

hypotension hyponatraemia hypokalaemia hypochloraemic alkalosis ototoxicity hypocalcaemia renal impairment (from dehydration + direct toxic effect) hyperglycaemia (less common than with thiazides) gout Submit answer

Answer 580

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

Answer 581

there is some evidence that statins may increase the risk of intracerebral haemorrhage in patients who've previously had a stroke. This effect is not seen in primary prevention. For this reason the Royal College of Physicians recommend avoiding statins in patients with a history of intracerebral haemorrhage

Answer 582

All people with established CV disease Anyone with QRISK \>10% T2DM: QRISK \>10 T1DM: diagnosed \>10 years ago or are \>40 or have established nephropathy

Answer 583

Gout Hypokalaemia Hyponatraemia Impaired glucose tolerance

Answer 584

Headache Flushing Ankle oedema

Answer 585

Bronchospasm Fatigue Cold peripheries

Answer 586

Postural hypotension

Answer 587

antibiotics: tetracycline, nitrofurantoin NSAIDs lithium metformin

Answer 588

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

Answer 589

antibiotics: erythromycin, rifampicin diazepam warfarin

Answer 590

Animal bite - co-amoxiclav A combination of doxycycline and metronidazole is recommended in the BNF if the patient is penicillin allergic. If facilities are not available to cleanse the wound the patient should be referred to the Emergency Department

Answer 591

many patients who take nitrates develop tolerance and experience reduced efficacy the BNF advises that patients who develop tolerance should take the second dose of isosorbide mononitrate after 8 hours, rather than after 12 hours. This allows blood-nitrate levels to fall for 4 hours and maintains effectiveness this effect is not seen in patients who take modified release isosorbide mononitrate

Answer 592

Dehydration Postural hypotension Hyponatraemia, hypokalaemia, hypercalcaemia Gout Impaired glucose tolerance Importence

Answer 593

Thrombocytopenia Agranulocytosis Photosensitivity rash Pancreatitis

Answer 594

Thiazide diuretics work by inhibiting sodium absorption at the beginning of the distal convoluted tubule (DCT). Potassium is lost as a result of more sodium reaching the collecting ducts. Thiazide diuretics have a role in the treatment of mild heart failure although loop diuretics are better for reducing overload. The main use of bendroflumethiazide was in the management of hypertension but recent NICE guidelines now recommend other thiazide-like diuretics such as indapamide and chlortalidone.

Answer 595

To convert from oral morphine to diamorphine the total daily morphine dose (60 \* 2 = 120mg) should be divided by 3 (120 / 3 = 40mg)

Answer 596

Binds to Na channels increasing their refractory period

Answer 597

Acute Chronic Idiosyncratic Teratogenic

Answer 598

Initially: dizziness, diplopia, nystagmus, slurred speech, ataxia (i.e. cerebellar signs) Later: confusion, seizures

Answer 599

Common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, histutism, coarsening of facial featrues, drowsiness) Megaloblastic anaemia (secondary to altered folate metabolism) Peripheral neuropathy Enhanced Vit D metabolism causing osteomalacia Lymphadenopathy Dyskinesia

Answer 600

Fever Rashes including TEN Hepatitis Dupuytren's contracture Aplastic anaemia Drug-induced lupus

Answer 601

Cleft palate and congenital heart disease

Answer 602

Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if: adjustment of phenytoin dose suspected toxicity detection of non-adherence to the prescribed medication

Answer 603

Chlorpromazine Each of the other four drugs may be associated with gynaecomastia rather than galactorrhoea

Answer 604

Sulphonylurea i.e. glimepiride Metformin Pioglitazone

Answer 605

Peripheral oedema is a common side effect of calcium blockers and the clinical picture is very suggestive of this. As the oedema is causing the patient concern then it would be appropriate to swap the amlodipine for a second line anti-hypertensive diuretic agent (e.g. indapamide). This helps to prevent polypharmacy and any further side effects/complications from adding an additional drug. If this does not resolve the oedema then further investigations would be required to identify the cause. Recommending lifestyle modifications would likely offer partial relief to the patient, but since it is affecting her throughout the day and night this is not a practical solution as would substantially affect her quality of life. However, lifestyle recommendations would also be advisable in addition to swapping amlodipine to indapamide.

Answer 606

Nifedipine Amlodipine Felodipine

Answer 607

Verapamil Diltiazem

Answer 608

Angina, HTN, arrhythmias Highly negatively inotropic Should not be given with beta-blockers as may cause heart block

Answer 609

HF Constipation, hypotension, bradycardia, flushing

Answer 610

Hypotension, bradycardia, heart failure, ankle swelling

Answer 611

Flushing, headache, ankle swelling

Answer 612

Loop diuretics Inihibta NaKCl triple transporter in ascending loop of henle-\> increased NaCl excretion

Answer 613

Thiazide diuretics Inhibt NaCl transporter in DCT Increase NaCl excretion

Answer 614

Aldosterone R antagonists Increase Na excretion Reduce K and H excretion

Answer 615

Block Na channels in collecting tubules Increase Na excretion Reduce K and H excretion

Answer 616

Carbonic anhydrase inhibotr Increase HCO3 excretion

Answer 617

Osmotic diuretic

Answer 618

Reduced Na Reduced K Reduced Ca Reduced Mg Raised urate Postural hypotension Tinnitus/deafness (rare)

Answer 619

Reduced Na Reduced K Raised Ca Raised urate Postural hypotension Impaired glucose tolerance

Answer 620

Raised K Gynaecomastia

Answer 621

Raised K GI upset

Answer 622

Rash: EM-\> SJS Peripheral tingling

Answer 623

Refractory hypokalaemia Anuric renal failure

Answer 624

Refractory hypokalaemia Gout Severe renal failure

Answer 625

Raised K Raised P Addison's

Answer 626

Sulfonamide hypersensitvity

Answer 627

Increased toxicity of: digoxin (due to hypokalaemia) NSAIDs Gent Li

Answer 628

Increased toxicity of: digoxin Li

Answer 629

Increased toxicity of: digoxin Li

Answer 630

Monitor U+Es May add K sparing diuretic to reduce K loss

Answer 631

Spiro doses: 25mg OD for HF 100-400mg OD for diuresis

Answer 632

Typically used in combination with K-wasting diuretics

Answer 633

Sulphonamide Used in open/closed angle glaucoma

Answer 634

ACEi Inhibit conversion of AngI-\> AngII

Answer 635

ARBs AngII R antagonists Don't inihbit kinin breakdown- therefore no cough

Answer 636

Hypotension: especially with diuretics, HF RF Hyperkalaemia Dry cough: 10-20% (secondary to raised bradykinin) Angioedema

Answer 637

As for ACEi but no cough

Answer 638

Suspected or confirmed bialteral RAS Angioedema/hypersensivity to ACEi ``` Salt substitutes (contain K) P/B ```

Answer 639

P/B Caution in RAS

Answer 640

Increased risk of renal failure with NSAIDs Diuretics, TCAs and antipsychotics-\> increased risk of hypotension Caution when used in conjunction with drugs that raie K

Answer 641

As for ACEi

Answer 642

Monitor U+Es: raise in creatinin \>30%-\> MRA Titrate dose Avoid in young women who might become pregnant: consider beta blockers Reduce dose in renal failure

Answer 643

Angiotensinogen is an a2-globulin released by liver Renin from the JGA converts angiotensinogen-\> AngI ACE is produced by pulmonary epithelial cells and converts AngI-\> AngII AngII acts via AT1R: Vasoconstriction Sympathetic activation Aldosterone release from adrenal coretx Increased renal Na absorption ADH release Ang2 is degraded by angiotensinases in RBCs

Answer 644

HF HTn Post-MI Angina Diabetic nephropathy

Answer 645

Heart: increase rate and contractility Kidney: increase renin release from JGA

Answer 646

Bronchi, GI: SM relaxation Skeletal muscle: arteriolar dilatation Liver + skeletal muscle: glycogenolysis and gluconeogenesis

Answer 647

Adipose tissue: lipolysis

Answer 648

Some beta-blockers have arteriorlar dilating effects which reduce TPR through blocking a1 R (e.g. carvedilol, labetalol, nebivolol) Cardioselective agents have redcuced B2 effects ISA (intrinsic sympathomimetic activity): partial agonist activity at adrenoreceptors: reduce bradycardia, reduce cold extermitites Lipophilic compounds are more likely to lead to CNS effects- propranolol, metoprolol Hydrophillic compounds may accumulate in renal failure: atenolol, sotalol Esmolol is V short acting and used IV

Answer 649

Angina HF Acute MI Arrhythmias HTN LongQT Prophylaxis vs variceal haemorrhage Migraine prophylaxis Thyrotoxicosis Glaucoma Anxiety

Answer 650

Bisoprolol Atenolol Metoprolol Esmolol Nebivolol

Answer 651

Cardioselective

Answer 652

Carvedilol Propanolol Sotalol Labetalol

Answer 653

Non-selective

Answer 654

Acebutolol Pindolol Oxprenolol

Answer 655

Carvediolol Labetaolol Nebivolol

Answer 656

Block beta Rs Actiions via Beta 1: reduce CO Reduce HR Reduce contracility Small reduction in BP: central effect + reduce renin Effects: Increase diastolic perfusion Reduce O2 demand Reduce afterload

Answer 657

Bronchospasms inc. cardioselective Reduced HR and BP Peripheral vasonconstiction: cold extremities Worsened Raynaud's/PVD Lethargy/fatigue Nightmares Metabolic: Reduce HDL Raised TGs Increased risk of new onset DM (especially with thiazides)

Answer 658

Asthma/bronchospasm PVD Severe bradyacrdia Severe HF 2nd/3rd degree AV block Caution in DM as increased likelihood of hypoglycaemia and can mask symptoms Reduce dose in renal impairment May reduce dose in hepatic impairment

Answer 659

Verapamil and diltiazem (risk of AV block and reduced HR) Enhanced antihypertensive effects with other anti-HTN drugs Block symptoms of hypoglycaemia with insulin

Answer 660

Propranolol is very lipid soluble and easily crosses the BBB-\> CNS effects (nightmares) Atenolol is water soluble and doesn't cross the BBB

Answer 661

Phenoxybenzamine Phenotalmine

Answer 662

Dozazosin Prazosin

Answer 663

Alpha blockers A1: systemic vasodilation Relaxation of internal urethral sphincter

Answer 664

The α2-adrenergic receptor is classically located on vascular prejunctional terminals where it inhibits the release of norepinephrine (noradrenaline) in a form of negative feedback.[3] It is also located on the vascular smooth muscle cells of certain blood vessels, such as those found in skin arterioles or on veins, where it sits alongside the more plentiful α1-adrenergic receptor.[3] The α2-adrenergic receptor binds both norepinephrine released by sympathetic postganglionic fibers and epinephrine (adrenaline) released by the adrenal medulla, binding norepinephrine (noradrenaline) with slightly higher affinity.[4] It has several general functions in common with the α1-adrenergic receptor, but also has specific effects of its own. Agonists (activators) of the α2-adrenergic receptor are frequently used in veterinary anaesthesia where they affect sedation, muscle relaxation and analgesia through effects on the central nervous system (CNS).[5]

Answer 665

Centrally acing alpha2 agonist Reduced CO Reduced PVR

Answer 666

Centrally acting alpha 2 agonist Prodrug-\> alpha methyl NA

Answer 667

Vasodilator arteries\>veins

Answer 668

Vasodilator arteries\>veins

Answer 669

Vasodilator

Answer 670

Postural hypotension Dizziness Headache Urinary incontinence (especially women) Blurred vision

Answer 671

Rebound HTN or withdrawal Postural hypotension Vonstipation Nausea Dry mouth

Answer 672

Blood dyscrasias Hepatotoxic Drug-induced lupus Drowsiness

Answer 673

Drug induced lupus Increased HR GI upset Headache

Answer 674

Hypertrichosis

Answer 675

Breastfeeding

Answer 676

Liver disease Depression

Answer 677

SLE Reduce dose in hepatic or renal impairment

Answer 678

Increase hypotensive effects of diuretics beta blockers CCBs

Answer 679

Avoid within 2w of MAOI

Answer 680

Phentolamine is short-acting and can be used to control BP in phaeo Phenoxybenzamine is long acting and can be used to maintain alpha blockade once BP controlled Doxazosin and tamsulosim are used in Rx of BPH

Answer 681

Mainly used in pregnancy

Answer 682

Hypertensive crisis

Answer 683

Bind alpha subunit of type-L Ca channel at distinct sites Prevent channel opening and inhibit Ca entry

Answer 684

All CCBs are vasodilators and reduce afterload. Also dilate coronary arteries Pre-capillary vasodilation-\> transudative oedema Dihydropiridines act only @ arterial Sm and can lead to reflex tachycarda, avoid short acting preparations Verapamil is highly negatively inotropic: CI in HF and with beta blockers Verapamil is also negatively chronotropic Diltiazem is less negatively inotropic and chronotropic than verapamil

Answer 685

HTN Angina AF

Answer 686

HTN (long acting) Angina: esp. good for Prinzemtal's Raynaud's

Answer 687

Nifedipine Amlodipine

Answer 688

Diltiazem Verapamil

Answer 689

Mainl arterial SM activity Vasodilation (inc. coronary) Particularly pre-capillary arterioles Reduced TPR-\> increased sympathetic tone-\> increased HR

Answer 690

Mainly cardiac activity Negative inotropic effect (esp. verapamil) Verapamil also slows conduction at SA and AV nodes Some activity at arterial SM

Answer 691

Flushing Headache Ankle oedema (especially amlodipine) Dizziness Hypotension Gingival hypertrophy (esp. nifedipine)

Answer 692

Headache Flushing AV block HF Reduced BP Ankle oedema Constipation Gynaecomastia (verapamil)

Answer 693

Cardiogenic shock Unstable angina Significant AS Within 1m of MI

Answer 694

HF 2nd/3rd degree AV block

Answer 695

Risk of reduced BP with alpha/beta-blockers Fx increased by grapefruti Fx reduced by: rifampicin, CBZ + phenytoin Nifedipine only: increases effects of digoxin

Answer 696

Risk of AB block, HF and asystole with beta blockers Increases effects of digoxin Fx of verapamil increased by: grapefruit juice macrolides Increased risk of myopathy with simvastatin

Answer 697

Indications: Angina Prinzmetal's angina HTN Raynaud's

Answer 698

Indications: Angina HTN Arrhythmias (verapamil)

Answer 699

NO donor with rapid onset and short duration (30 minutes) High FPM Mainly venodilation-\> reduced preload Small increase in coronary vasodilation

Answer 700

Long-acting nitrates ISMN is active metabolite of ISDN MN avoids unpredictable FPM of DN Tolerance develops quickly: need 8h drug free period (usually at night)

Answer 701

Reduced BP (inc postural) Headache Syncope Dizziness Flushing Reflex tachycardia

Answer 702

AS and MS Reduced BP Constrictive pericarditis Tamponade HOCM Reduced Hb Glaucoma (closed) Hypovolaemia Raised ICP

Answer 703

Sildenafil, tadakafil and vardenefil are all CI due to reduced BP Recued effects of heparin if given IV

Answer 704

SL spray or tabs 300ug Used for relief of pain in angina, ACS

Answer 705

K+ATP channel activator + nitrate component Arterial and venous dilator

Answer 706

Inhibits funny current in SAN-\> reduced pacemaker activity-\> reduced HR

Answer 707

Inhibits fatty acid oxidation-\> increased myocardial glucose use

Answer 708

Inhibits late Na current

Answer 709

Headache Flushing Dizziness GI ulcers

Answer 710

Visual changes Reduced HR and HB

Answer 711

Cardiogenic shock

Answer 712

Reduced BP or HR ACS Strong CYP inhibitor

Answer 713

Sildenafil-\> low BP

Answer 714

Subject to hepatic induciton/inhibition

Answer 715

Uncontrolled angina

Answer 716

Angina (useful if beta-blocker CIed)

Answer 717

Inhibit Vit K epoxide reductase Prevents recycling of Vit K-\> functional Vit K deficiency Inhibits synthesis of factors 2, 7, 9, 10, C and S Initially procoagulant as protein S is depleted first

Answer 718

Treatment: VTE Prophylaxis: VTE AF Mechanical heart valves Large anterior MI Dilated cardiomyopathy/LV aneurysm Patients with Ca-associated VTE should be treated for 6m with therapeutic dose of LMWH rather than warfarin

Answer 719

Long t1/2: 40hrs Takes 16h to affect INR Peak INR effect of a dose seen @ 2-3d Effect of a given dose lasts 4-5d Highly albumin bound CyP metabolism

Answer 720

Haemorrhage, bruising Skin necrosis (due to protein S deficiency) Purple toe syndrome (cholesterol embolism) Osteoporosis Hepatic dysfunction

Answer 721

Hepatic impairment: avoid if severe Renal impairment: avoid if severe Alcoholics

Answer 722

Pregnacny: teraogenic in 1st trimester, foetal haemorrhage in 34d PUD Severe HTN Caution if R/L, recent surgery, risk of falls

Answer 723

Enzyme inhibitors EtOH Simvastatin NSAIDs Dipyridamole Amiodraone Abx (may also reduce) Cranberry juice

Answer 724

CBZ Rifampicin OCP Phenyotin Barbs St John's Wort

Answer 725

2. 5 3. 5 if happen on warfarin

Answer 726

Cause known: 6w No cause: 3m

Answer 727

Cause known: 3m No cause: 6m

Answer 728

Cause known: 3m No cause: 6m

Answer 729

Indefinite

Answer 730

Indefinite

Answer 731

Indefinite

Answer 732

Indefinite

Answer 733

Indefinite

Answer 734

classically: hypokalaemia\* increasing age renal failure myocardial ischaemia hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis hypoalbuminaemia hypothermia hypothyroidism drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

Answer 735

A key concept for the exam is to understand that salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis. In children metabolic acidosis tends to predominate

Answer 736

serum concentration \> 700mg/L metabolic acidosis resistant to treatment acute renal failure pulmonary oedema seizures coma

Answer 737

Headache Contraindicated in epilepsy Taken weekly

Answer 738

Photosensitivity Oesophagitis

Answer 739

Dizziness Neuropsychiatric distrubance Contraindicated in epilepsy Taken weekly

Answer 740

Whilst many antibiotics can lower the seizure threshold, this effect is seen particularly with quinolones. The BNF advises that quinolones 'should be used with caution in patients with a history of epilepsy, or conditions that predispose to seizures'

Answer 741

Metformin can cause lactic acidosis in patients with impaired renal function. NICE recommend that the dose should be reviewed in patients an eGFR\<45 ml/min and stopped in patients with an eGFR\<30 ml/min. The patient here is on metformin and has an eGFR\<30 ml/min with an ABG showing a non-hypoxic metabolic acidosis. His symptoms are also typical of metabolic acidosis. While statins do pose a risk of rhabdomyolysis, which would also produce symptoms of muscle pain, the normal creatinine kinase excludes this. It also does not explain the abnormal ABG. The other options are inconsistent with the presentation and blood results.

Answer 742

Phenytoin Ciclosporin CCBs (especially nifedipine)

Answer 743

Amiodarone Indomethacine

Answer 744

Ethambutol Amiodarone metronidazole

Answer 745

The BNF states that PPI's are used at the lowest effective dose for the shortest period and the need for long-term treatment should be reviewed periodically. Long-term use of PPI's can mask the symptoms of gastric cancer. They can also increase the risk of osteoporosis and fractures -due to malabsorption of calcium and magnesium.

Answer 746

This patient has classical signs of Achilles tendon rupture. Tendon damage is a well documented complication of quinolone therapy. It appears to be an idiosyncratic reaction, with the actual median duration of treatment being 8 days before problems occur

Answer 747

There are a number of causes of gynaecomastia in males and it is important to rule out sinister ones such as kidney failure, endocrine disturbances, liver failure or malignancy. Another key cause is medication related, in this case the finasteride taken by this patient can cause gynaecomastia. Finasteride works by blocking 5-alpha-reductase inhibitors those reducing the production of dihydrotestosterone and therefore shrinking the prostate, however side effects can include gynaecomastia and sexual dysfunction.

Answer 748

Amiodarone - MOA: blocks potassium channels

Answer 749

Viral infection 2o to sharing needles Bacterial infection 2o to injection VT OD may lead to respiratory depression and death Psychological problems Social problems

Answer 750

Opioid misuses

Answer 751

5-HT3 antagonists are antiemetics used mainly in the management of chemotherapy related nausea. They mainly act in the chemoreceptor trigger zone area of the medulla oblongata. Examples ondansetron granisetron Adverse effects constipation is commo

Answer 752

Patients taking liver enzyme-inducing drugs Malnourished patients Patients who have not eaten for days

Answer 753

Management of COPD patients ## Footnote prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis adjust target range to 94-98% if the pCO2 is normal

Answer 754

Phenytoin may cause a megaloblastic anaemia by altering folate metabolism

Answer 755

(note how everything is increased - fluid, BP, K+, hair, gums, glucose) nephrotoxicity hepatotoxicity fluid retention hypertension hyperkalaemia hypertrichosis gingival hyperplasia tremor impaired glucose tolerance hyperlipidaemia increased susceptibility to severe infection

Answer 756

Other examples of muscarinic antagonists used in urinary incontinence include oxybutynin and solifenacin. Examples of muscarinic antagonists used in different conditions include ipratropium (chronic obstructive pulmonary disease) and procyclidine (Parkinson's disease). Tamsulosin is an alpha blocker.

Answer 757

Serotonin syndrome is a disorder characterised by serotonin excess, usually due to the use of 2 or more serotonergic drugs. Manifestations of the syndrome include changes in mental status, neuromuscular changes and autonomic overactivity. Clinically, this can be observed as hypertension, tachycardia, flushing and sweating, hyperflexia, clonus and muscle rigidity. Other potential signs include fever and changes in mental status, including agitation. Serotonergic drugs that are associated with serotonin syndrome include tramadol, selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI), triptans and St Johns wort. The management of serotonin syndrome involves discontinuation of all serotonergic drugs and supportive care. If required, benzodiazepine can be administered to control agitation. In moderate to severe cases, 5-HT antagonists (e.g. cyproheptadine and chlorpromazine) are sometimes administered.

Answer 758

12hrs post dose

Answer 759

Trough levels immediately before dose

Answer 760

At least 6h post-dose

Answer 761

Ciprofloxacin is a synthetic fluoroquinolone with a broad antimicrobial spectrum. Fluoroquinolones have been reported to enhance the effect of warfarin, and appropriate laboratory tests should be routinely monitored. The exact mechanism of the warfarin-ciprofloxacin interaction is unknown. Ciprofloxacin is postulated to affect gut flora, displace warfarin from albumin, and interfere with hepatic metabolism by inhibiting the cytochrome P-450 enzyme system

Answer 762

The most likely cause of this patients presentation is intestinal obstruction. Intestinal obstruction is one of the more under-recognised complications of clozapine therapy, yet one of the more serious. Gastric hypomotility is common in patients who are treated with clozapine, and its presentation can range from a simple constipation to more severe conditions such as intestinal obstruction, bowel ischaemia and necrosis. The important pieces of information to consider when answering this question are the recent prescription of clozapine, the presence of constipation previous to current presentation, and his physical presentation of acute abdominal pain and vomiting with distension. When answering a question such as this, recent prescriptions of medications prior to the deterioration of their physical condition should raise the thought that maybe one of the medications is causing the symptoms. In this scenario, the patient has recently been prescribed clozapine, fluoxetine and lactulose. Therefore, considering each of these medications and their side effects is a must. The patients presentation, and recent past medical history, provides a good indication of what could be the underlying issue. The patient has presented with acute abdominal pain and vomiting. When you consider this with the recently experienced constipation, it becomes clear that this patient is likely suffering from an obstruction, as opposed to the other options on offer. Constipation would be an inappropriate answer to this question. Although he has had constipation recently, and abdominal pain could be a presentation of constipation, vomiting is not generally observed in constipation. This would means that this diagnosis is less likely. Bezoars are indigestible masses that become trapped in the gastrointestinal tract. They can occur when individuals consume a variety of items, including hair, soil, chewing gum etc. These items form a mass, which ultimately becomes lodged in the gastrointestinal tract, often requiring surgical intervention to relieve the obstruction. The symptoms that the patient in this scenario has experienced could be explained by a bezoar, however, we do not have any evidence that he consumes any items that may lead to a bezoar. Furthermore, the recent commencement of clozapine means that we cannot select a bezoar as the most likely cause of this patients symptoms above intestinal obstruction. Similarly, we do not have any evidence that the patient ingests foreign objects, meaning that this cannot be classed as a likely cause in this question. Appendicitis could explain the acute presentation of this patient. However, the fact that the patient experienced constipation prior to him developing acute abdominal pain and vomiting means that appendicitis is less likely.

Answer 763

Management of hiccups chlorpromazine is licensed for the treatment of intractable hiccups haloperidol, gabapentin are also used dexamethasone is also used, particularly if there are hepatic lesions

Answer 764

Schedule 1 includes drugs that can only be used with controlled licence i.e. permission from Home Secretary. Includes LSD and cannabis Schedule 2 - Special permission for storage of the drug is required. Includes heroin, cocaine, amphetamines Schedule 3 - Controlled with no register, includes Barbituates, midazolam, Schedule 4 - No need safety custody or register but all invoices needed and proper destruction - anabolic steroids, some benzodiazepines Schedule 5 - Drug invoices only needed - e.g. codeine

Answer 765

Alfentanil, buprenorphine and fentanyl are the preferred opioids in patients with chronic kidney disease.

Answer 766

Bromocriptine is a treatment for galactorrhoea, rather than a cause

Answer 767

This patient has developed erythema multiforme which is a known complication of carbamazepine use.

Answer 768

Methadone or buprenorphine

Answer 769

Cisplatin Methotrexate Doxorubicin

Answer 770

Amiloride and spironolactone are both potassium-sparing diuretics. Combining the two may result in life-threatening hyperkalaemia.

Answer 771

Dipyridamole inhibits phosphodiesterase

Answer 772

Rash with infectious mononucleosis

Answer 773

Cholestasis

Answer 774

GI upset Prolonged QT

Answer 775

Lowers seizure threshold Tendonitis

Answer 776

Reaction following EtOH ingestion

Answer 777

Photosensitivity

Answer 778

Rashes, including photosensitivity Pruritus Suppression of haematopoeisesis

Answer 779

Sildenafil is a phosphodiesterase type V inhibitor

Answer 780

The correct answer is Fomepizole

Answer 781

The correct answer is Atropine

Answer 782

This patient has suffered a respiratory arrest likely due to opioid toxicity. Therefore a 400 microgram bolus of naloxone should be administered. It is important to remember that naloxone has a short half life and therefore further naloxone will likely be required.

Answer 783

H. pylori eradication: PPI + amoxicillin + clarithromycin, or PPI + metronidazole + clarithromycin The BNF recommends a regimen containing amoxicillin and clarithromycin as first-line therapy

Answer 784

BZDs increase the frequency of opening Barbs increase the duration of channel opning

Answer 785

Donepezil may cause bradycardia and atrioventricular node block.

Answer 786

anti-malarials: primaquine ciprofloxacin sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

Answer 787

Mefloquine (brand name Lariam) is used for both the prophylaxis and treatment of certain types of malaria. There has long been a concern about the neuropsychiatric side-effects of mefloquine. A recent review has however led to 'strengthened warnings' about the potential risks. The following advice is therefore given: certain side-effects such nightmares or anxiety may be 'prodromal' of a more serious neuropsychiatric event suicide and deliberate self harm have been reported in patients taking mefloquine adverse reactions may continue for several months due to the long half-life or mefloquine mefloquine should not be used in patients with a history of anxiety, depression schizophrenia or other psychiatric disorders patients who experience neuropsychiatric sife-effects should stop mefloquine and seek medical advice

Answer 788

Constipation Sleep distrubances Tachycardia

Answer 789

Diclofenac is now contraindicated with any form of cardiovascular disease

Answer 790

Diuretics, ACE-inhibitors and angiotensin II receptor antagonists may cause lithium toxicity. The BNF advises that neurotoxicity may be increased when lithium is given with diltiazem or verapamil but there is no significant interaction with amlodipine. Alpha-blockers are not listed as interacting with lithium but they would not be first-line treatment for hypertension. The NICE hypertension guidelines suggest amlodipine wouldn't be a bad first choice, even if we ignore his lithium treatment.

Answer 791

Carbamazepine is an inducer of the P450 system. This in turn increases the metabolism of carbamazepine itself - auto-induction

Answer 792

Na channel blockers (local anaesthetics) All slow conduction: subclasses have additional effects on AP Use-dependent: preferentially block open or refractory Na channels

Answer 793

Quindine, procainamide, disopyramide

Answer 794

A, SAN, AVN, V

Answer 795

Prolonged-\> increased AP duration

Answer 796

Ventricular arrhythmias

Answer 797

Anti-AChM Negative inotropes

Answer 798

Lignocaine, mexiletine Ventricular only Shorten repolarisation-\> normal or reduced AP durations

Answer 799

Ventricular arrhythmias following MI

Answer 800

Flecainide Sites of actioin: A, SAV, AVN, V Little effect on repolarisation Used in pre-excited AF (WPW) and acute AF

Answer 801

Beta blockers: metorpolol, propranolol, esmolol, atenolol Sites of action: A, SAN, AVN, V MOA: Increase refractory period of AVN-\> slow AVN conduction Prevent arrhythmias due to sympathetic discharge e.g. following MI INdicated Post-MI, rate control in AF, SVT Caution: negative inotropes

Answer 802

Amiodarone and sotalol Sites of action: A, SAN, AVN, V MOA: K channel blockers Increase refractory period and prolong QTc Indications: V and SV arrhythmias, pre-excited AF Can-\> arrhythmias esp. TdeP

Answer 803

CCVs: verapamil and diltiazem (non-DHPs) Site of action: AVN MOA: SLow AVN conduction Indications: prevent SVT recurrence, AF (rate), acute SVT Caution: negative intropes

Answer 804

Digoxin Adeonsine

Answer 805

Cardiac glycoside MOA: Positive inotrope: inhibits myocye Na/K ATPase-\> raised Na and Ca Negative chronotrope: slows AV conduction-\> reduced rate and increased AVN refractory period Only slows resting rate, not exercise rate Indications: SVT and AF

Answer 806

Acts @ A1 Rs in cardiac tissue-\> myocyte hyperpolarisation Transient AV block Indicated in SVTs

Answer 807

Adenosine beta-blcoker Verapamail Digoxin Use: AF, SVT

Answer 808

Class 1a, 1c and amiodarone

Answer 809

Cardiac glycoside

Answer 810

Ventricular arrhythmias (esp. post-MI

Answer 811

Ventricular arrhythmias (esp. post-MI)

Answer 812

Pre-excited AF (WPW) Cardioversion in AF Suppression of ventricular ectopics

Answer 813

SVT AF/flutter Pre-excited AF V. arrhythmias

Answer 814

AF/flutter SVT (HF)

Answer 815

SVT: Dx and Rx

Answer 816

VT, VF, TdeP Anti-muscarinic

Answer 817

Drowsiness Paraesthesia Dizziness Bradycardia-\> cardiac arrest

Answer 818

Strong -ve inotrope Oedema Dyspnoea

Answer 819

Eye: corneal microdeposits Thyroid: hyper/hypo Lung: pulmonary fibrosis GI/liver: raised LFTs, N/V Neuro: peripheral neuropathy Skin: photosensitvity, blue-grey discolouration, phlebitis (give centrally)

Answer 820

Toxicity: Any arrhythmia Nausea Xanthopsia Confusion Hyperkalaemia Chronic: Gynaecomastia Reverse tick ECG (not a sign of toxicity)

Answer 821

Bronchospasm Chest pain Flushing Nausea Light-headedness

Answer 822

Heart block (2/3)

Answer 823

Heart block

Answer 824

Structural heart disease Post-MI

Answer 825

Thyroid disease Sinus bradycardia TdP

Answer 826

Complete heart block VF/VT HOCM SVTs 2o to WPW

Answer 827

Asthma Heart-blcok (2/3) Sick sinus syndrome

Answer 828

Cimetidine increases lidocaine levels

Answer 829

beta blocker and CCB-\> increased risk of HV Increased levels of: digoxin warfarin phenytoin Increased risk of ventricular arrhythmias with: Class 3/1a antiarrhythmics TCAs, antipsychotics Erythromycin

Answer 830

Dig fx/toxicity increased by: CCB (especially verapamil) Amiodarone (halve dig dose) Diuretics (loop/thiazide use due to redcued K) Reduced digoxin intestinal absorption with: antacids cholestyramine

Answer 831

Function prolonged by dipyridamole Function decreased by theophylline

Answer 832

IV use only

Answer 833

Accumulates in body Very long t1/2 (10-100d) Extensively tissue bound hence requires loading dose Monitor: TFTs, LFTs K CXR Avoid sunlight

Answer 834

Caution: Renal excretion therefore beware of renal impairment Monitor: U+Es Drug levels Load then maintenance

Answer 835

t1/2= 9-10s

Answer 836

Irreversible, non-selective COX inhibitor Redces platela TxA2-\> reduced paltelet activation-\> reduced platelet adhesion, aggregation Relatively platelet-specific @ low dose 75-100mg

Answer 837

Thienopyridine irreversible adenosine R antagonist: inhibits ADP-induced fibriongen binding to GPIIb/IIIa

Answer 838

MAb or synthetic inhibitors of GPIIb/IIIa

Answer 839

PEDI: increased cAMP inhibits plt aggregation TxA2 synthetase inhibitor

Answer 840

Also antiADP These agents reduce the aggregation ("clumping") of platelets by irreversibly binding to P2Y12 receptor

Answer 841

Gastritis Gastric ulceration Bleeding Bronchospasm Renal failure Gout Otototixc in OD: tinnitus

Answer 842

Bleeding: esp. GI or intracranial GI upset Dyspepsia/PUD TTP (rare) Blood dyscrasias (rare)

Answer 843

Bleeding Thrombocytopneia

Answer 844

\<16y (Reyes syndrome) except in Kawasaki;s Active PUD Bleeding disorders Gout Renal disease (GFR \<10ml/min) P/B Caution: asthma uncontrolled HTN

Answer 845

Severe liver disease B

Answer 846

Increased risk of bleeding with other anti-coagulants and anti-platelets Increases function of sulphonylureas, methotrexate

Answer 847

Avoid with warfarin

Answer 848

Enhances effects of adensoine

Answer 849

Stop 7d before surgery if significant bleeding expected Max dose: 4g/d

Answer 850

Prodrug converted by heaptic CYP enzymes Used following bare-metal or drug eluting stents Stop 7d before sx

Answer 851

Only abiciximab can be given PO Given to high-risk patients with NSTEMI

Answer 852

May be used with aspirin in 2o prevention of stroke

Answer 853

HMG-CoA reductase inhibitors: block rate-limiting step in cholesterol synthesis Leads to reduced hepatocyte cholesterol-\> increased hepatic LDLRs-\> reduced LDL cholesterol ``` Raises HDl Reduces TGs (mild) ```

Answer 854

Fibrates Stimulate lipoprotein lipase: reduce TG, reduce LDL, increase HDL

Answer 855

Anion exchange resin Bind bile acids and prevent enterohepatic recyclig, therefore liver must synthesis more bile acids from cholesterol-\> increased LDLRs

Answer 856

Inhibit cholesterol and TG synthesis Raises HDL

Answer 857

Inhibits intestinal cholesterol absorption Pro-drug

Answer 858

Reduce TGs

Answer 859

Pancreatic lipase inhibitor-\> impaired absorption of dietary fat

Answer 860

Myositis- stop if CK 5x ULN as can lead to rhabdo and ATN Deranged LFTs GI upset

Answer 861

Gallstones GI upset Reduced appetite Myositis Blood dyscrasias

Answer 862

GI upset: bloating, constipation, N/V Can raise TGs Impairs absorption of fat soluble drugs and vitamins (ADEK)

Answer 863

Flushing NV

Answer 864

GI upset Myalgia

Answer 865

GI upset Steatorrhoea Abdominal distension Reduced absorption of fat-soluble drugs and vitamins

Answer 866

Liver disease Pregancy

Answer 867

GB disease PBC Reduced albumin (esp. nephrotic syndrome) R L P B

Answer 868

Complete biliary obstruction

Answer 869

Peptic ulcer

Answer 870

Cholestasis

Answer 871

Increased risk of myositis with: fibrates macrolides azoles grapefruit juice protease inibitors ciclosporin nicotinic acid Milw W+

Answer 872

Increased risk of myositis Increased function of anti-diabetics W+

Answer 873

Reduces absorption of other drugs e.g. digoxin

Answer 874

Increased risk of myositis with statins

Answer 875

Warfarin: difficulty controlling INR

Answer 876

Monitor: LFTs and CK Take statins nocte as increased cholesterol synthesis overnight

Answer 877

Use: hyperTG

Answer 878

Don't take within 3h of other drugs

Answer 879

Factors 2, 7, 9, 10 Immediate reversal of anticogaulation Temprorary effect- give Vit K Risk of VTE and very expesnive

Answer 880

Onset of actions = 6h Oral is as efficacious as IV Oral Vit K can-\> prolonged anticoagulant resitsance. avoid if continuing anticoagulation Continuing warfarin: 0.5mg slow IV Discontinuing Warfarin 2.5-5mg IV

Answer 881

Low risk: avoid dehydration, regularly flex ankles Mod risk: as above + compression travel socks. Previous VTE, GA within last 1-2m High risk: as above, consider LMWH before flight. Sx under GA within last m

Answer 882

Co-factor for ATIII: inhibits 2, 10, 11 and 12 LMWH and fondaparinux only inhibit factor 10

Answer 883

LMWH has longet t1/2 and response is more predictable- no monitoring required UH has rapid onset and short t1/2: useful when rapid control over effects needed e.g. risk of bleeding Less risk of HIT and osteoporosis with LMWH

Answer 884

Treatment: VTE ACS Acute arterial obstruction Prophylaxis: VTE Coagulation in extra-corporeal circuits

Answer 885

Thrombocytopenia: immune mediated. Develops 6d after intitiaion-\> thrombosis Osteoporosis: LT use Hyperkalaemia: heparin inhibits aldosterone

Answer 886

Bleeding disorders Plt \<60 Previous HIT PU Cerebral haemorrhage Severe HTN NeuroSx

Answer 887

e.g. enoxaparin Prophylaxis: 20-40mg pre and post-surgery Treatment: 1.5mg/kg/24h

Answer 888

5000iU bolus IV over 30 mins Infuse UH @ 18iu/kg/h Check APTT @ 6h (aim for 1.5-2x control)

Answer 889

Bleeding Allergic responses: rash, anaphylaxis Reperfusion dysrhythmias after MI Hypotension Development of Abs: can only use once

Answer 890

Bleeding, hypotension, reperfusion dysrhythmias

Answer 891

Alteplase: infuse Give with UH heparin IV for 24-48h to avoid rebound hypercoagulable state

Answer 892

Haemorrhagic stroke at any time Ischaemic stroke in last 6m CNS trauma or neoplasms Major trauma/surgery in last 3w GI bleed within last 1m Known bleeding disorders Aortic dissection Non-compressible puncture e.g. LP

Answer 893

TIA in last 6m Warfarin Pregnancy or within 1w post-partum Refractory resus Refractory HTN (\>180/110) Advanced liver disease Infective endocarditis Acute peptic ulcer

Answer 894

Omeprazole

Answer 895

The absolute risk reduction is 8% (16% - 8%). 100/8 = 12.5, so rounding up the the next integer this gives at NNT of 13. i.e. you would need to give the new drug to 13 people to ensure that you prevented one death. Numbers needed to treat and absolute risk reduction Numbers needed to treat (NNT) is a measure that indicates how many patients would require an intervention to reduce the expected number of outcomes by one It is calculated by 1/(Absolute risk reduction) and is rounded to the next highest whole number Experimental event rate (EER) = (Number who had particular outcome with the intervention) / (Total number who had the intervention) Control event rate (CER) = (Number who had particular outcome with the control/ (Total number who had the control)

Answer 896

Red man syndrome is associated with rapid intravenous infusion vancomycin. It is a common adverse reaction of intravenous vancomycin use and is a distinct entity from anaphylaxis due to vancomycin use. Typical symptoms include redness, pruritus and a burning sensation, predominantly in the upper body (face, neck and upper chest). Severe cases can be associated with hypotension and chest pain. The pathophysiology of red man syndrome is attributed to vancomycin-related activation of mast cells with release of histamine. The management of red man syndrome involves cessation of the infusion, and when symptoms have resolved, recommencement at a slower rate. In patients who are more symptomatic antihistamines can be administered, and may require intravenous fluids if the syndrome is associated with hypotension.

Answer 897

He should wait for at least 3 months after stopping treatment

Answer 898

Underlying causes of confusion need to be looked for and treated as appropriate, for example hypercalcaemia, infection, urinary retention and medication. If specific treatments fail then the following may be tried: first choice: haloperidol other options: chlorpromazine, levomepromazine In the terminal phase of the illness then agitation or restlessness is best treated with midazolam

Answer 899

Isotretinoin adverse effects teratogenicity - females MUST be taking contraception low mood dry eyes and lips raised triglycerides hair thinning nose bleeds

Answer 900

Migraine and hormone replacement therapy (HRT) ## Footnote safe to prescribe HRT for patients with a history of migraine but it may make migraines worse

Answer 901

Bumetanide, like furosemide, is a loop diuretic.

Answer 902

This is a classic description of an oculogyric crisis, a form of extrapyramidal disorder

Answer 903

Bosentan - endothelin-1 receptor antagonist

Answer 904

Adenosine dipyridamole enhances effect aminophylline reduces effect

Answer 905

Quinine Abciximab NSAIDs Diuretics: furosemide Abx: penicllins, sulphonamides, rifampicin Anticonvulsants: carbamazepine, VPA Heparin

Answer 906

Ivabradine is indicated for the symptomatic relief of angina in patients with a heart rate \>70, as an alternative to first line therapies. It is also indicated for the treatment of chronic heart failure (NYHA II-IV) in addition to standard therapy, in patients with a heart rate of \>75. The mode of action of ivabradine is by inhibition of If channels (known as funny channels), I = current, f =funny. These funny channels are so called because of their unusual features compared to other ion channels. They are mixed sodium and potassium channels found in spontaneously active regions of the heart such as the sinoatrial node and are triggered by hyperpolarisation. Activated funny channels allow an influx of positive ions, triggering depolarisation and are therefore responsible for the spontaneous activity of cardiac myocytes. By inhibiting If channels ivabradine delays depolarisation in the sinoatrial node and therefore selectively slows heart rate. The commonest side effect caused by ivabradine is transient luminous phenomenon (reported by up to 15% of patients), such as bright spots appearing in their field of vision. Less commonly blurred vision is reported. Patients should be informed of this common side effect before starting the medication. The visual side effects of ivabradine are likely to be mediated by inhibition of a channel similar to the If channel found in the retina called the Ih channel. The h = hyperpolarisation-activated, these channels were formerly called IQ channels, Q = queer, again for their unusual characteristics. Ivabradine is metabolised by oxidation through cytochrome P450 3A4 (CYP3A4) only. Therefore drugs that induce (e.g rifampicin) or inhibit (e.g erythromycin, itraconazole) CYP3A4, will decrease or increase the plasma concentration of ivabradine respectively. In this case the patient has been taking the potent CYP3A4 inhibitor Itraconazole, this would have increased the plasma concentration of ivabradine, resulting in the visual side effects experienced.

Answer 907

A 79-year-old man with a known history of mixed type dementia (Alzheimer's and vascular) is assessed in memory clinic as his family have noticed a further deterioration in his memory and cognition. His mini-mental state score is 12 and as such he is commenced on memantine. Which of the following best describes the mechanism of action of memantine? ## Footnote Serotonin receptor agonist Dopamine receptor antagonist Acetylcholinesterase inhibitor Butyrylcholinesterase and acetylcholinesterase inhibitor NMDA antagonist

Answer 908

The correct answer here is Amitriptyline - a tricyclic antidepressant (TCA) overdose. Whilst the main effect of TCAs is to increase serotonin and noradrenaline in the brain by slowing re-uptake, they also block histamine, cholinergic and alpha 1 receptors. Therefore in overdose the anti-cholinergic effects give dilated pupils, dry skin, confusion, urinary retention and tachycardia. Divergent pupils are a common finding in tricyclic overdose. TCAs are also cardiotoxic by inactivating sodium channels in the heart leading to, as seen here, a potential prolongation of the QTc interval and a widened QRS complex. This can potentially lead to ventricular arrhythmias. Other effects of TCAs not included here include seizures and a metabolic acidosis. In overdose sertraline may present with serotonin syndrome. The Glasgow coma scale may be reduced and pupils dilated, but skin would not be dry. A classic feature of serotonin syndrome is hyperreflexia, often with muscle rigidity and tremor, which is not described here. Additionally QTc prolongation is unlikely with selective serotonin reuptake inhibitors (citalopram is an exception). Cocaine produces sympathetic effects - agitation, restlessness, increased heart rate and blood pressure. In severe toxicity hyperthermia and rhabdomyolysis may occur. It would not cause a reduced GCS or altered QRS duration on ECG. MDMA (ecstasy) excess presents similarly to cocaine, with increased psychomotor agitation, palpitations and hyperthermia. Additionally teeth grinding (bruxism) is noted frequently. Diazepam ingestion could cause a reduced GCS due to its sedative effects. However it would not generally affect pupil size, heart rate or ECG. It is associated with respiratory depression.

Answer 909

Nateglinide The BNF recommends avoiding alpha-blockers for 4 hours after sildenafil

Answer 910

Large fall in LDL-cholesterol

Answer 911

Vincristine is associated with peripheral neuropathy. Urinary hesitancy may develop secondary to bladder atony.

Answer 912

Amphotericin B

Answer 913

Terbinafine

Answer 914

Griseofulvin

Answer 915

Flucytosine

Answer 916

Caspofungin

Answer 917

Pyrazinamide mechanism of action: converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I hyperuricaemia causing gout arthralgia, myalgia hepatitis

Answer 918

Dopamine pro-drug Crosses BBB and converted to Da by dopa-decarboxylase

Answer 919

Non-selective Da agonist

Answer 920

Ergot-derived Da agonists

Answer 921

Synthetic Da agonists

Answer 922

Selective MAO-B inhibitors Prevent intraneuronaol Da degradation Buccal preparations have better bioavailability

Answer 923

COMTI Inhibit peripheral Da degradation

Answer 924

Da release Inhibit peripheral Da degradation

Answer 925

Muscarinic antagonsits Reduce tremor

Answer 926

Dyskinesia On-off Psychosis ABP reduced Mouth dryness Insomnia N/V EDS

Answer 927

Very emetogenic Give domperidone for 2d before starting Rx Injection site reactions

Answer 928

Fibrosis Vasopsapasm: cardiac, digital GI upset Posural hypotension Drowsiness Neuropsychiatric synbdromes

Answer 929

GI upset Insomnia (selegiline) Postural hypotension (no cheese reaction)

Answer 930

Reddish brown urine GI distrubance Dyskinesias Tolcapone is hepatotoxic

Answer 931

GI uspet Sleep disturbance Livedo reticularis Neuropsychiatric syndromes

Answer 932

Anti-AChM Memory impairment Confusion

Answer 933

Closed angle glaucoma MAO-Is Melanoma

Answer 934

CV disease Prophyria Psychosis

Answer 935

Gastric ulcer Epilepsy

Answer 936

Function reduced by antispchotics HTN crissis with non-selective MAOIs Anti-HTNs enhance hypotensive function Food affects absorption (proteins specifically)

Answer 937

Levels increased by: Octreotide Macrolides

Answer 938

Interact with sympathomimetics

Answer 939

Always give wih peripheraly dopa-decarboxylase inhibitor e.g. carbidope, benserezide Loss of response within 2-5y Give domperidone for N/V Short T1/2 so requires at least TDS dosing

Answer 940

Only give S/C Rescue pen for freezing

Answer 941

Not often used in parkinsonism due to SEs

Answer 942

Used alone to delay need for L-DPPA Adjunct to L-DOPA to reduced end-of-dose effects

Answer 943

Reduces off period of L-DOPA Tolcapone has better efficacy but requires LFT monitoring

Answer 944

May be used in PD for late onset dyskinesia

Answer 945

Useful in drug-induced parkinsonism and mild PD in young patients, esp. tremor

Answer 946

Peak dose dyskinesias End of dose dyskinesia/akinesia: deterioration as dose wears off On-off effect: unpredictable fluctuations in motor performance unrelated to timing of dose

Answer 947

Na channel blockers Use-dependant Inhibit action potential generation

Answer 948

Ihibits glutamate release

Answer 949

Ca channel blocker

Answer 950

GI upset Hepatotoxicity Appetitie increased Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenicity, tremor, thrombocytopenia Encephalopathy due to raised ammonia

Answer 951

Skin reactions e.g. SJS Blood dyscrasia (reduced WCC0 Reduced Na (SIADH) Foetal NTDs GI upset Dose-related: dizziness/vertigo Ataxia Diplopia

Answer 952

Acute: Drowsiness Cerebellar fx Rash Chronic: Gingival hyperplasia Hirsutism and acne Reduced folate

Answer 953

Rashes (SJS, TEN, lupus) Cerebellar effects Blood dyscrasias Hepatotoxic

Answer 954

Visual field defects

Answer 955

Acute porphyria Personal/FHx of severe liver dysfunction L/P

Answer 956

Unpaced AV conduction defects Hx of BM depression Porphyria MAOIs

Answer 957

Don't give IV if cardiac dysrythmias Caution: DM, hypotension, L/H, P

Answer 958

Liver disease

Answer 959

?makes tonic-clonic seizures worse

Answer 960

Function reduced by: antimalarials antidepressants antipsychotics some anti-epileptics Levels increased by cimetidine Increases fx of: aspirin LTG Warfarin

Answer 961

Reduces FX of: COCP Doxy corticosteroids Anti-elipetics Nifedipine Warfarin Levels increased by: macrolides cimetidine diltiazem and verapamil EtOH NSAIDs Esomeprazole Levels reduced by: rifampicin antipsychotics

Answer 962

Fx reduced by: OCP PHE, CZM TCAs and SSRIs Levels increased by VPA

Answer 963

CYP inhibitor 1st line for generalised seizures Monitor: FBC, LFTs Most teratogenic AED

Answer 964

Has active metabolite produced in the liver CYP inducer Monitor: serum levels U+E, LFT, FBC

Answer 965

V. albumin bound CYP idnucer 0 order kinetics Monitor: FBC

Answer 966

Monitor: U+Es, LFTs, FBS, clotting Stop if any sign of rash Safest for pregnancy

Answer 967

Only used for childhood absence seizures

Answer 968

5HT 1b/1d R agonist Reverses dilatation of cerebral vessels

Answer 969

Partial 5HT R agonist

Answer 970

5HT2 R antag and antihistamine

Answer 971

5HT and Na reuptake inhibitor

Answer 972

Sensation of tingling/heat/ tightness/pressure Dizziness Flushing

Answer 973

GI upset Dizziness

Answer 974

Drowsiness Increased appetite and weight

Answer 975

Anti-cholinergic Anti-adrenergic Anti-histamine OD: prolonged QTc

Answer 976

IHD Coronary vasopasm PVD Hx of MI, CV, TIA HTN (moderate/severe)

Answer 977

As for triptans

Answer 978

Recent MI (w/i 3m) Heart block Liver disease

Answer 979

Increased risk of CNS toxicity with SSRIs

Answer 980

MAOIs-\> HTN and CNS excitiation Levels increased by SSRIs, cimetidine Increased risk of arryhthmias with amiodarone

Answer 981

Used for Rx of acute attacks Don't use for 2-3x /w --\> chronic migraine

Answer 982

Migraine prophylaxis

Answer 983

Hepatic metabolism Used for prophylaxis

Answer 984

Inihibts PLA-\> reduced PG and PAF Reduced PMN extravasation-\> increased PMN in blood Lymphopenia Phagocytosis Reduced Ab proudction Reduce cytokines and protelytic enzymes

Answer 985

Random polymer of amino acids found in MBP ?acts as decoy

Answer 986

Anti-a4 integrin

Answer 987

GABAb agonist Skeletal muscle relaxant

Answer 988

Prevents Ca release from SR Skeleatl muscle relaxant

Answer 989

Antimuscarinic

Answer 990

`Flu-like symptoms Injection site reactions

Answer 991

Flu-like symptoms Injection site reactions

Answer 992

Sedation Reduced tone Nausea Urinary distrubance

Answer 993

Hepatotoxicity GI upset

Answer 994

Dry mouth GI upset Blurred vision

Answer 995

Decompensated L Severe depression

Answer 996

Liver disease

Answer 997

Myasthenia GI/bladder obstruction

Answer 998

High dose up to 1g/d for acute MS flares Short course: 3-5d

Answer 999

Relapsing remitting or secondary progressive MS Monitor for hepatotoxicity

Answer 1000

Relapsing remitting MS

Answer 1001

Rx painful muscle spasms Don't withdraw abruptly: hyperthermia increased spasticity

Answer 1002

Used for detrusor instability

Answer 1003

Vomiting regulated by comiting centre and CTZ, both located in the medulla CTZ: Oustide BBB therefore accessible to drugs Also receives input from vestibular system regarding motion Express D2 and 5HT3 Rs CTZ projects to vomiting centre Vomiting centre: Controls visceral and somatic functions incolved in vomiting Receives input from CTz Also receives muscarinic and histaminergic input (H1)

Answer 1004

D2R H1 5HT3 mACh

Answer 1005

D2 R antagonist Prokinetic action in GIT: increased absorption of other drugs

Answer 1006

5HT3 R antag

Answer 1007

H1 R antagonist

Answer 1008

Anti-muscrainic

Answer 1009

Steroid: unknown anti-emetic effect

Answer 1010

Neurkonin R blocker

Answer 1011

EPSEs: dystonias, oculogyric crisis Drowsiness, rash, allergy, raised prolactin

Answer 1012

Constipation Headache

Answer 1013

Anti-muscrainic

Answer 1014

\<20y GI obstruction L Prolacitnoma

Answer 1015

Avoid if prolonged QT

Answer 1016

Severe HF MAOIs can increase antimuscarinic fx

Answer 1017

Closed angle gluacoma BPH

Answer 1018

Increased risk of EPSEs with antipsychotics, TCAs, SSRIs

Answer 1019

Levels reduced by Rifampicin CBZ, PHE Avoid with drugs that prolong QTc

Answer 1020

Redcues function of SL GTN

Answer 1021

Indications: GI causes of nausea Chemo, morning after pill, opiates PD Migarine Vestibular (prochlorperzine) Domperidone doesn't cross BBB so less EPSEs cf. others

Answer 1022

Indications: post-op CTx CYP metabolism

Answer 1023

Indications: Opioids but not in ACS Vestibular

Answer 1024

Indications: prophylaxis vs motion sickness Hypersalivation

Answer 1025

Indications: Chemo (adjunct)

Answer 1026

Cognitive: headache, agitaition, confusion, coma Autonomic: sweating, increased HR, palpitations, HTN, hyperthermia Somatic: myoclonus, clonus, hypertonia

Answer 1027

Metabolises monoamines MAO-A: adrenaline, norad, sertoonin, tyramine, dopamine MAO-B: dopamine

Answer 1028

Metabolic acidosis Anti-AChM: dialted pupils CNS: hypertonia, hyperreflexia, extensor plantars, seizures Cardiac: increased HR, prolonged QT Pulmonary: hypoventilation Rx: NaHCO3

Answer 1029

TCA Inhibit 5HT and NA uptake

Answer 1030

MAOI Inhibit monomaine metabolism A: 5hT B: Da

Answer 1031

N/V/Diarrhoea Insomnia Headache Sexual dysfunction SIADH Withdrawal effects

Answer 1032

HTN GI upset Long QT SIADH Rash

Answer 1033

alpha1: postural hypotension sedation H1: drowsiness weight gain AntiAChM Arrhthmias, esp. heart block

Answer 1034

Sedation Hypotension Anti-AChM

Answer 1035

Active mania Children \<18y (except fluoxetine)

Answer 1036

HF (3/4) Uncontrolled HTN

Answer 1037

Recent MI Arrhythmias Severe L Mania Caution: Glaucoma BPH

Answer 1038

P450 inhibitor- increase levels of TCAs Benzos Clozapine Haldol CBZ and PHE SSRI + MAO-\> serotonin syndrome Increased risk of bleeding with aspirin

Answer 1039

SSRI + MAOI-\> serotonin syndrome Increased risk of bleeding with aspirin

Answer 1040

MAOIs-\> HTN and CNS excitiation Levels increased by SSRIs Increased risk of arrhythmias with amioarone TCAs lower seizure threshold- reduced AED effects Increased fx of antipsychotics

Answer 1041

Hypertensive crisis: tyramine containing foods Opioids- esp. pethidine SSRIs + TCAs-\> serotonin syndrome

Answer 1042

Takes 4-6w for full clinical effect Don't stop suddenly Avoid within 2w of MAOI Used: depression OCD Eating disorders Anxiety disorders

Answer 1043

2nd line anti-depressant Stop if signs of rash

Answer 1044

Avoid within 2w of MAOI

Answer 1045

Moclobemide is reversible and is selective for MAOI-A- less chance of interactions

Answer 1046

Antipyretic Analegsic

Answer 1047

Morphine Diamorphine Buprenorphine Fentanyl Pethidine Oxycodone

Answer 1048

Codeine Dihydrocodeine Tramadol

Answer 1049

Analgesic effect mediated by u receptor

Answer 1050

Hepatic failure in OD

Answer 1051

CNS: resp depression sedation N/V euphroia miosis anti-tussive dependance Non-CNS constipation urinary retention pruritus bradycardia, hypotension

Answer 1052

Sedation Cerebellar fx Dizziness Peripheral oedema

Answer 1053

Aboid in patients with acute resp depression Head injury: can't assess pupils

Answer 1054

FX reduced by antidepressants antimalarials

Answer 1055

Rx OD with naloxone Reduce does in: R, L, elderly

Answer 1056

Mood stabiliser

Answer 1057

Typical antipsychotics Da antagonists

Answer 1058

Atypical antipsychotics Da antagonists

Answer 1059

Promote GABA binding to GABA A Rs

Answer 1060

Potenitate GABAA receptors

Answer 1061

Polyuria and polydipsia Nephrotoxic CI upset FIne tremor Hypothyroidism Toxicity: Coarse tremor Cerebellar signs AKI Hyper-reflexia Coma

Answer 1062

Sedation Anti-AChM EPSE Neuroleptic malignant syndrome Prologned QT, postural hypotension Increased PRL Sexual dysfunction Increased weight

Answer 1063

Clozapine: agranulocytosis, increased weight DM Olanzapine: increased weight, DM, sedation Quetiapine: sedation Risperidone: increased weight, increased PRL

Answer 1064

Sedation Respiratory depression Withdrawal

Answer 1065

Sedation Resp depression

Answer 1066

Hypothyroidism P/R/H

Answer 1067

Toxicity increased by NSAIDs Diuretics (esp. thiazides) ACEi/ARB

Answer 1068

FX incresed by: Li TCAs

Answer 1069

Levels increased by: antipsychotics azoles marcolides

Answer 1070

Monitor: drug levels, U+Es, TFTs Use: acute mania, prophylaxis of BAD, resistant depression Increased toxicity when hyponatraemic or dehydratied- increased Li absoprtion in renal PCT

Answer 1071

Monitor FBC , U+Es, LFTs

Answer 1072

Can still-\> EPSEs @ high doses (apart from clozapine) Clozapine used in Rx of refractory schizophrenia and better at treating negative symptoms

Answer 1073

Rx OD with flumazenil Hepatic metabolism IV diazepam is given as an emulsino to reduce risk of thrombophlebitis

Answer 1074

CYP inducer Primidone is phenobarbitol prodrug

Answer 1075

Penicillins Cephalosporins Carbapenems

Answer 1076

Bactericidal Inhibit bacterial transpeptidase enzyme required for wall construction

Answer 1077

Bactericidal: Inhibit bacterial transpeptidase enzyme, required for cell wall construction Generations have increasing activity vs gram negative

Answer 1078

Bactericidal: inhibit bacterial transpeptidase enzyme required for cell wall construciton V. broad spectrum: gram -ve, positive and anaerobes Pseudomonas Imipenem is rapidly inactivated by the kidney and must be given with cilastatin which blocks its metabolism

Answer 1079

Streps N. meningitidis Syphillis

Answer 1080

Amoxicillin Ampicillin

Answer 1081

Pneumococcus Listeria E. coli Enterococci

Answer 1082

Penicillinase resistant e.g. MSSA

Answer 1083

Piperacillin Ticarcillin

Answer 1084

Severe CAP UTI

Answer 1085

Severe HAP Sepsis

Answer 1086

Cephalexin Cefaclor

Answer 1087

Cefuroxime

Answer 1088

Ceotaxime Ceftriaxone Ceftazidime Cefixime

Answer 1089

Mod/severe CAP GI sepsis Pre-op

Answer 1090

Meningitis Epiglottitis Gonorrhoea SBP

Answer 1091

All GM+Ve except MRSA Most G-ve Neutropenic sepsis

Answer 1092

Hypersensitivity: rash, EM, anpahylaxis GI upset Maculopapular rash with EBV

Answer 1093

GI upset AAC

Answer 1094

Hypersensitivity (10% cross-reactivity with cephs)

Answer 1095

May reduce Fx of OCP Increased by probenecid

Answer 1096

Chloramphenicol Aminoglycosides Tetracyclines Oxazilidinones Macrolidse Streptogramins Lincosamides

Answer 1097

Bacteriostatic: 50s subunit

Answer 1098

Aminoglycosides Bactericidal: amino-acyl site of 30s subunit

Answer 1099

Tetracyclines Bacteriostatic: 30s subunit

Answer 1100

Oxazolidinones Bacteriostatic, 23s component of 50s subunit

Answer 1101

Macrolides Bacteriostatic: 50s subunit

Answer 1102

Streptogramins Bacteriostatic: 50s subunit

Answer 1103

Lincosamides Bacteriostatic- 50s subunit

Answer 1104

Conjuncitivits

Answer 1105

Gm sespsi Neutropenic sepsis Otitis externa Anti-pseudomonal

Answer 1106

COPD exacerbation Acne Chalmydia Rickettsia Brucella Lyme disease

Answer 1107

MRSA and VRE No activity vs Gm-ve

Answer 1108

Pen allergic Aytpical pneumonias Chlamydia H. pylori

Answer 1109

Acitve vs gm + ve cocci and bacteroides Osteomyeltisis MRSA

Answer 1110

Irreversible aplastic anaemia Grey baby syndrome

Answer 1111

Nephrotoxic Ototoxic

Answer 1112

GI upset Hypersensitivity Bone deposition

Answer 1113

Blood dyscrasias

Answer 1114

Prolonged QT Dry skin Cholestatic hepatitis

Answer 1115

AAC Hepatotoxicity

Answer 1116

MG Caution in R: alter dose and time

Answer 1117

Children M12 L R

Answer 1118

Caution in R and L

Answer 1119

Caution if prologned QT

Answer 1120

Reduced absorption with milk, antacids

Answer 1121

Toxicity increased by: frusemide cephs vanc ciclopsorin

Answer 1122

P450 inhibitor increase W effects Increase digoxin

Answer 1123

MUst monitor levles- peak and trough Must be given IV

Answer 1124

Linezolid is a non-selective MAOI- avoid SSRI, TCAs and tyramine Monitor FBC

Answer 1125

Also have GI prokinetic action

Answer 1126

Only used when other agents failred

Answer 1127

Stop drug if patient develops diarrhoea

Answer 1128

Glycopetides: inhibit cell wall synthesis Unable to penetrate Gm-ve outer wall Poor oral absoprtion

Answer 1129

Fluoroquinolones Inhibit DNA synthesis

Answer 1130

Nitroimidazole Bactericidal Inhibits DNA synthesis

Answer 1131

Rifamycins Bactercidal RNA synthesis inhibitors

Answer 1132

Cell membrane toxin

Answer 1133

Cell membrane toxin

Answer 1134

Bacteriostatic Inhibits MTB cell wall synthesis

Answer 1135

Bactericidal

Answer 1136

Bacteriostatic

Answer 1137

Bacteriostatic

Answer 1138

Aerobic and anaerobic Gm +ve RMSA HAN Infective endocarditis AAC (PO)

Answer 1139

Broad spectrum esp. Gm-ve GI infections: campy, shig Pseudomonas esp. in CF Prostatitis, PID Anthrax

Answer 1140

Anaerobes GI sepsis Aspiration pneumonia AAC H. pylori PID Protozoa: Giardia

Answer 1141

Mycobacteria Legionella Prophylaxis vs meningitis

Answer 1142

UTI PCP Toxoplasmosis

Answer 1143

MRSA: alternative to linezolid and syndercid

Answer 1144

Active vs Gm-ve |nhaled for CF

Answer 1145

Active vs staphs Impetigo (topical) Blepharitis (topical) Osteomyelitis (PO)

Answer 1146

Nephrotoxic Ototoxic: tinnitus, SNHL Hypersensitivity rash Neutropenia

Answer 1147

Long QT Gi upset Tendoninitis +/= rupture Reduced seizure threshold Photosensitivity

Answer 1148

Metallic taste GI upset Metro: gynaecomastia`

Answer 1149

Yellow secretions Hepatitis

Answer 1150

Blood dyscrasias EM-\> SJS EN Nephro + hepatotoxicity

Answer 1151

Optic neuritis

Answer 1152

Hepatitis Gout

Answer 1153

Peripheral neuropathy Hepatitis

Answer 1154

Reduce dose in renal impairment

Answer 1155

Severe R and L P

Answer 1156

Caution in gout

Answer 1157

P450 inhibitor Antacids-. reduce absoprtion

Answer 1158

Avoid EtOH- disulfiram-like reaction

Answer 1159

P450 inducer: reduced W Reduced OCP Redcued AEDs

Answer 1160

P45 Inhibitor

Answer 1161

Must monitor levels Pre-dose trough

Answer 1162

Aldehyde dehydrogenase inhibitor

Answer 1163

Rifaximin has v poor oral absoprtion and is used in hepatic encephaloapthy

Answer 1164

Stop immediately if rash or dyscrasias occur

Answer 1165

Monitor vision- colour goes first

Answer 1166

Monitor LFts

Answer 1167

Increaesd risk of SEs if slow acetylator Give with pyridoxine

Answer 1168

Needs 2nd abx to prevent resistance

Answer 1169

Proguanil and atovaguooone

Answer 1170

Artemether and lumefantrine

Answer 1171

Benign malaria Prophylaxis

Answer 1172

Bening malaria- eliminate liver stage

Answer 1173

Falciparum malaria Prophylaxis

Answer 1174

Prophlyaxis

Answer 1175

Falciparum malaria

Answer 1176

Visual change: rarely retinopathy Seizures EM-\> SJS

Answer 1177

Haemolysis if G6PDD Methaemogolbinaemia

Answer 1178

Abdo pain GI upset

Answer 1179

Nausea and dizziness Neuropsychiatric signs

Answer 1180

Prolonged QTc Abdo pain GI upset

Answer 1181

Caution in G6PDD

Answer 1182

Caution in G6PDD

Answer 1183

Avoid in renal impairment in possible

Answer 1184

Hx of epilepsy or psychosis

Answer 1185

Hx of arrythmias Prolonged QT Caution in R/L

Answer 1186

Guanosine analogue Phosphorylated by viral thymidine kinase Di and triphosphorylatd by cellular kinase Acicilovir triphosphate inhibites viral DNA pol and is a poor substrate for host DNA pol and TK

Answer 1187

Aciclovir prodrug Converted to aciclovir by hepatic esterases during FPM Better oral bioavailability

Answer 1188

Pro drug with same MOA as aciclovir

Answer 1189

2-deoyguanosine analagoue Phosphorylated to dGTD analoge by viral UL97 Triphosphate competitively inhibits viral DNA pol IV only

Answer 1190

Ganciclovir prodrug with better oral bioavailability

Answer 1191

Binds to pyrophosphate binding site and inhibits viral DNA pol Doesn't require viral TK IV only

Answer 1192

Inhibits viral DNA pol No activation required

Answer 1193

Genital herpes Herpes meningitis Herpes zoster Varicella zoster Bells palsy

Answer 1194

CMV Rx: retinitis, pneumonitis CMV prophylaxis HHV-6 Tx disease

Answer 1195

Resistant CMV infections

Answer 1196

GI upset ARF Encephalopathy

Answer 1197

BM suppression

Answer 1198

Nephrotoxic- avoid in renal tx

Answer 1199

Nephrotoxic

Answer 1200

Caution in renal impairment

Answer 1201

Increased risk of BM suppression with zidovudine

Answer 1202

Nucleoside reverse transcriptase inibitors Except Tenofovir which is a nucleoTide RT inhibitor

Answer 1203

PIs Inhibit viral protease required for viral assembly Ritonavir is used to boost levels of other PIs

Answer 1204

Non-competitive inhibition of reverse transcripatse NB nevirapine is used to prevent HIV transmission during pregnancy

Answer 1205

Inhibit integration of transcribed viral DNA into host genome

Answer 1206

CCR5 inhibitor Binds CCR5 preventing interaction with gp120 inhibiting attachment of HIV

Answer 1207

Fusion inhibitor Binds gp41 and inhibits fusion

Answer 1208

Hepatitis: stop if raised LFTs Lactic acidosis (type B) Painful peripheral neuropathy Rash GI distrubance

Answer 1209

Metabolic syndrome Lipodystrophy

Answer 1210

Insomnia Vivid dreams EM-\> SJS

Answer 1211

Hypersensitivity at injection site

Answer 1212

Fat redistribution: reduced SC fat, increased abdo fat, buffalo hump Insulin resistance Dyslipidaemia

Answer 1213

Immune reconstitution inflammatory syndrome Improvement in immune function 2o to ARV Rx Marked inflammatory reaction vs residual opportunistic organisms Paradoxical worsening of symptoms on initiaion of ARVs

Answer 1214

Imidazoles

Answer 1215

Allylamines

Answer 1216

Echinocandins

Answer 1217

Interacts with ergotsterol-\> pore formation Fungicidal

Answer 1218

Blocks ergosterol synthesis by inhibiting 14a-demethylase-\> reduced membrane fluidity Inhibits replication Prevents hyphae formation Broad spectrum Fungistatic

Answer 1219

Block ergosterol synthesis by inhibiting squalene epoxidase-\> membrane disruption Fungicidal

Answer 1220

Inhibit beta-glucan synthesis Fungicidal vs yeasts Fungistatic vs moulds

Answer 1221

Inhibits DNA/RNA synthesis

Answer 1222

Disrupts spindle formation in mitosis

Answer 1223

Severe systemic fungal infections (IV): cryptococcal meningitis pulmonary asperigollosis systemic candidiasis

Answer 1224

Candidiais: cutaneous, vaginal, mucosal, oesophageal

Answer 1225

Chronic mucocutaneous candidiasis

Answer 1226

Dermatophyte infections Mucocutabeous candidiasis

Answer 1227

Oral/vag/oesophagus candida Alternative to ampho B for systemic infections

Answer 1228

Blasto/histo/coccidio Sporotrichosis Chromomycosis Aspergillus

Answer 1229

Invasive candida or aspergillus in immunocompromised

Answer 1230

Invasive candida, mucor and asperigullus in immunocompromsied

Answer 1231

Dermatophyte infections

Answer 1232

Invasive aspergillosis or candidiasis Empiric Rx for fungal infection in febrile neutropenia

Answer 1233

Cryptococcal meningitis in combination with amphotericin B

Answer 1234

Dermatophyte infections of skin/hair/nails

Answer 1235

Nephrotoxic IV reaction (after 1-3h): fever, hypotension, n/v

Answer 1236

Toxic if given IV

Answer 1237

Hepatotoxic Reduces androgen synthesis

Answer 1238

Photophobia Rash Hepatotoxic

Answer 1239

GI effects Hive Deranged LFTs Reversible agranulocytosis

Answer 1240

V low toxicity GI upset Hypersensitivity

Answer 1241

Bone marrow suppression Deranged LFTs

Answer 1242

Monitor Cr PO version is non toxic

Answer 1243

PO or topical

Answer 1244

P450 inhibitor

Answer 1245

Very slow acting

Answer 1246

Biguanide Insulin sensitiser: reduced gluconeogensis, increased peripheral glucose use, reduced LDL and VLDL

Answer 1247

Thiazolidinedione Peripheral insulin sensitiser PPAR gamma ligand (nuclear receptor involved in glucose and lipid homeostasis)

Answer 1248

Sulfonylureas Insulin secretagogues Block hyperpolarising K channels on beta cells-\> depolarisation and insulin release

Answer 1249

Meglitinides Insulin secretagogues Block hyperpolarising K channel

Answer 1250

Insulin secretagogue GLP-1 analgoue: increased insulin and sensitisation

Answer 1251

Insulin secretagogues DPP-4 inhibitor (DPP4 breaks down endogenous GLP-1)

Answer 1252

Intestinal alpha-glucosidase inhibitor Delays carbohydrate absortion-\> reduced post prandial glucose Little effect on fasting lgucose

Answer 1253

Lactic acidosis GI upset Anorexia-\> weight loss

Answer 1254

Weight gain Fluid retention Hepatotoxicity May exacerbate HF

Answer 1255

Hypogylcaemia (can be prolonged) Weight gain (increased appetite) GI upset Headache

Answer 1256

Hypoglycaemia

Answer 1257

Hypoglycaemia GI upset

Answer 1258

Hypoglycaemia GI upset

Answer 1259

Flatulence Loose stools/diarrhoea Abdo pain/bloating Hepatotoxicity

Answer 1260

Caution in R/H Contrastmdia General anaesthesia Recent MI

Answer 1261

H/L Insuline use ACS

Answer 1262

Severe L/R Acute prophyria

Answer 1263

Fx increased by: sulphonamides trimethoprim NSAIDs Warfarin Fibrates

Answer 1264

Renally excreted: reduce dose or avoid if reduced eGFR Cannot cause hypos

Answer 1265

Don't use with insulin V. protein bound Hepatic metabolism Monitor LFTs

Answer 1266

Renally excreted V. albumin bound Caution in elderly with reduced renal function Avoid lon-acting in elderly

Answer 1267

V short acting- reduced risk of hypo

Answer 1268

Administer by SC injection

Answer 1269

Monitor LFTs

Answer 1270

Somatostatin analgoue

Answer 1271

GH R antagonist

Answer 1272

11beta hydroxylase inhibitor: inhibits adrenal cortisol production

Answer 1273

Diarrhoea Gallstones

Answer 1274

Hypoadrenalism

Answer 1275

Use: prolactinoma can be used in acromegaly Monitor heart with echo

Answer 1276

Acromegaly Carcinoid

Answer 1277

Acromegaly

Answer 1278

Can be used in Cushing's particularly if resistant to surgery

Answer 1279

Calcimimetic- reduces PTH secretion

Answer 1280

Phosphate binder

Answer 1281

Bisphosphonates- reduce osteoclastic bone resorption

Answer 1282

Increased bone formation Reduced bone resorption

Answer 1283

Recombinant PTH pulsatile admin-\> increased bone formation and reduced resorption

Answer 1284

Anti- RANKL reduced osteoclast activation

Answer 1285

1a (OH) Vit D3

Answer 1286

1,25 (OH) D3

Answer 1287

GI upset Oesophagitis Osteonecrosis of the jaw Diffuse MSK pain

Answer 1288

DRESS syndrome: Drug Rash Eosinophilia Systemic symptoms

Answer 1289

GI obstruction

Answer 1290

Achalasia Oesophageal stricture

Answer 1291

Skeletal malignancies Paget's Severe R

Answer 1292

Used for Rx of 2o HPT in ESRF

Answer 1293

Used to reduce PO4 in ESRF

Answer 1294

Used to: prevent osteoporotic fractures prevent osteoporosis Hypercalcaemia of malignancy Paget's Take with glass of water on an empty stomach 30 mins before breakfast and sit uprighht

Answer 1295

Used if bisphosphonates not tolerated

Answer 1296

Contraception Reduces dysmenorrhoea, menorrhagia, PMT, benign breast disease, ovarian and endometrial cancer, risk of PID

Answer 1297

Reduces: hot flushes, vaginal dryness, increased libido Redcued urinary frequency/urgency Reduced risk of bowel Ca Reduced risk of osteoporotic #s

Answer 1298

Increased risk of VTE Increased risk of breast Ca Small increased risk of IHD Gallstones Cholestatic jaundice Breast tenderness Hepatoma

Answer 1299

N/V Headache Increased weight Breast tenderness

Answer 1300

Increased risk of Ca: breast, endometrial, ovarian increased risk of VTE Increased risk of stroke and IHD Cholestatic jaundice

Answer 1301

Personal Hx of VTE Risk of VTE Risk of arterial disease Hx of breast Ca Migraine

Answer 1302

Severe arterial disease Hx of breast cancer

Answer 1303

Oestrogen dependant breast Ca Hx of breast Ca UnDx vaginal bleeding VTE

Answer 1304

FHx of VTE BMI \>30 (avoid if over 35) LT immobilisation Hx of superficial thombrophlebitis \>35y/o, avoid if \>50 Smoking

Answer 1305

FHx of arterial disease DM HTN Smoking (avoid if \>40/d) \>35y, avoid if \>50 Migraine without aura, avoid if migraine with aura

Answer 1306

P450 metabolism: reduced effectiveness with enzyme inducers Increases fx of steroids

Answer 1307

P450 met: reduced effectiveness with enzyme inducers

Answer 1308

Don't need extra contraception when taking with oral Abx that don't induce liver enzymes unless D/V

Answer 1309

Excess Ca risk disappears within 5y of stopping

Answer 1310

Fentanyl Buprenorphine

Answer 1311

\>40mg pred for \>7d \>3w treatment Recently received repeated courses

CPT Flashcards

(1448 cards)