extras

Question 1

enzyme inhibitors (potentiate) ODEVICES

Answer 1

Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin/Cimetidine
Ethanol (acutely)
Sulphonamides

Question 2

enzyme inducers (decrease efficacy) - PCBRAS

Answer 2

Phenytoin
Carbamazepine

Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonylureas

Question 3

alpha 1 adrenoreceptor agonist

Answer 3

decongestgants eg phenylephrine

vasopressors eg metraminol/norad

Question 4

alpha 1 adrenoreceptor antagonist

Answer 4

antagonist:
BPH eg tamsulosin
HTN eg doxasozin

Question 5

beta 1 adrenoceptor agonist

Answer 5

inotropes eg dobutamine

Question 6

beta 1 adrenoceptor antagonist

Answer 6

selective beta blockers eg bisoprolol

Question 7

beta 2 adrenoceptor agonist

Answer 7

bronchodilators eg salbutamol

Question 8

beta 2 adrenoceptor antagonist

Answer 8

non-selective beta blockers eg propanolol

Question 9

dopamine agonist

Answer 9

PD eg ROPINIROLE

prolactinomas eg BROMOCRIPTINE

Question 10

dopamine antagonist

Answer 10

antipsychotics eg HALOPERIDOL

anti-emetics eg METOCLOPRAMIDE

Question 11

GABA agonist

Answer 11

benzodiazepines

Question 12

GABA antagonist

Answer 12

flumazenil

Question 13

Histamine-1 Antagonist

Answer 13

antihistamines eg cetirizine

Question 14

Histamine-2 Antagonist

Answer 14

Antacids eg ranitidine

Question 15

mACh agonist

Answer 15

Glaucoma eg pilocarpine

Question 16

mACh antagonist

Answer 16

Brady eg atropine
Bronchodilators eg ipratropium
Urge incontinence eg oxybutynin

Question 17

nACh agonist

Answer 17

Smoking cessation eg varenicicline

Depolarising muscle relaxant eg suxamethonium

Question 18

nACh antagonist

Answer 18

Non-depolarising muscle relaxant eg atracurium

Question 19

Serotonin agonist

Answer 19

acute migraine eg sumatriptan

Question 20

Sertonin antagonist

Answer 20

Anti-emetics eg ondansetron (5HT3A antagonist)

Question 21

oral codeine or oral tramadol to oral morphine

Answer 21

divide by 10

Question 22

oral morphine to oral oxycodone

Answer 22

divide by 1.5

• preferred in mild-moderate renal impairment (eGFR 30-60)
• causes less sedation/vomiting/pruritus

Question 23

oral morphine to SC morphine

Answer 23

divide by 2

Question 24

oral morphine to SC diamorphine

Answer 24

divide by 3

Question 25

oral morphine to fentanyl 100 patch

Answer 25

dividie by 100 (over 24h)

Question 26

SE of opiates x3

Answer 26

nausea (transient) vomiting (transient) constipation (persistent)

Question 27

opiate for use if eGFR <30

Answer 27

alfentanil, fentanyl, buprenorphine

Question 28

starting tx doses for opiods in palliative care - MR morphine, IR oromorph + one more thing

Answer 28

15mg MR morphine BD (= total 30mg oral morphine) + 1/6 of 30 = 5mg IR oromorph (for breakthrough pain) + laxative

Question 29

general prescribing for nauseated individual

Answer 29

1st line: cyclizine 50mg 8 hourly (except in cardiac cases as can worsen fluid retention) 2nd line: metoclopramide, 10mg 8 hourly (avoid in PD, use domperidone instead, and avoid in young women, risk of acute dystonia)

Question 30

general prescribing in vomiting without nausea

Answer 30

cyclizine 50mg up to 8 hourly | metoclopramide 10mg up to 8 hourly

Question 31

N&V in palliative care: GASTRIC STASIS causes + drug of choice

Answer 31

causes; opiods | drugs; metoclopramide (CI - BOWEL OBSTR), domperidone

Question 32

N&V in palliative care: CHEMICAL causes + drug of choice

Answer 32

causes; opiods, hypercalcaemia, chemo | drugs; ondansetron, haloperidol, levomepromazine

Question 33

N&V in palliative care: VISCERAL/SEROSAL causes + drug of choice

Answer 33

causes; constipation, oral candidiasis | drugs; cyclizine, levopromazine

Question 34

N&V in palliative care: RAISED ICP causes + drug of choice

Answer 34

causes; cerebral metastasis | drugs; cyclizine +/- dexamethasone

Question 35

N&V in palliative care: VESTIBULAR causes + drug of choice

Answer 35

causes; motion-related, base of skull tumours | drugs; cyclizine

Question 36

N&V in palliative care: CORTICAL causes + drug of choice

Answer 36

causes; anxiety, pain, fear, anticipatory nausea | drugs; BDZ (lorazepam), cyclizine

Question 37

bony mets pain x3

Answer 37

1st - analgesia 2nd - bisphosphonates 3rd - radiotherapy

Question 38

antihistamines; target, example, indications + SE

Answer 38

target H1>M>D2 acts on CTZ, vestibular, VC PROMETHAZINE - INDIC: motion sickness, labyrinth disorders, hyperemesis gravidarum, pre- and post-operatively - SE: dizziness, fatigue, tinnitus, sedation

Question 39

D2 receptor antagonist; examples x2

Answer 39

METOCLOPRAMIDE (avoid in BO - prokinetic), DOMPERIDONE

Question 40

D2 receptor antagonist; target, indications + SE

Answer 40

target D2>>H1>>>M acts on CTZ INDIC: GI motility disorders, uraemia, radiation sickness, cancer chemo SE: CNS - EPSEs, drowsy, dizzy, anxiety Endo - hyperprolactinaemia, galactorrhoea

Question 41

M receptor antagonist - target + example

Answer 41

M>>>D2/H1 acts on CTZ, vestibular, VC -Hyoscine/scopolamine + Diphenhydramine (little effect once nausea est)

Question 42

M receptor antagonist; indication + SE

Answer 42

indication: pre-op medication, motion sickness SE: antimuscarinic - dry mouth, mydriasis, constipation, drowsy

Question 43

5-HT3 receptor antagonist - target, example, indication + SE

Answer 43

5-HT3 receptor antagonist, 5 HT2, acts on CTZ, peripherals ondansetron (mild nausea use alone, severe nausea combine with steroids) indication: chemo sickness, RT sickness, post-op N&V SE: headache, flushing, constipation