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Flashcards in Final Year Pharm Deck (17):
1

Name two biologics used in the management of asthma and their mechanism of action.

Omalizumab - anti-IgE Mepolizumab - anti-IL-5

2

Name two specific anti-fibrotic treatments for idiopathic pulmonary fibrosis.

Pirfenidone and Ninetadinib

3

A 23 year old rugby player has had his dislocated shoulder reduced using entonox and midazolam. His conscious level decreases and he has falling oxygen saturations despite high flow oxygen. What drug should be prescribed and what is its mechanism of action?

The correct drug to prescribe in this situation is flumazenil. Flumazenil is a selective benzodiazepine receptor antagonist which is used to reverse the sedating effects of benzodiazepines. However, it should not be used in a patient with chronic benzodiazepine use as it may induce dangerous withdrawal. It has a high risk of inducing seizures; therefore its use should be very limited to seriously unwell or dereriorating patients.

4

An 80 year old woman has recently undergone a total hip replacement. She has become very drowsy, with small pupils and a respiratory rate of 8/minute. What has caused the status of this patient? What is the antidote? What is the half-life of the antidote compared to the causative drug and how will that affect your management?

This patient is suffering from a morphine overdose. The antidote for this is naloxone which is an opiate antagonist which can be given intravenously or intramuscularly. Naloxone has a shorter half-life than morphine so a patient may require multiple doses or a naloxone infusion.

5

19 year old male is brought to A&E with a range of symptoms and signs including agitation, euphoria, blurred vision, slurred speech, ataxia and slate-gray cyanosis.

Which of the following options is most likely to be the causative poison in this scenario?

(a) Tricyclic antidepressants

(b) Benzodiazepines

(c) Opiate analgesics

(d) Salicylates

(e) Sympathomimetics

(f) Methanol

(g) Ethylene glycol

(h) Insulin

(i) Carbon monoxide

(j) anti-psychotics

(k) Volatile solvents

The correct answer is (k) volatile solvents. Volatile solvents cause euphoria, hence the desire to sniff glue or huff paint. Symptoms of intoxication are common and CNS disturbance may be severe. Slate-grey cyanosis is due to methaemoglobinaemia which is treated with methylene blue.

6

A 22 year old woman comes to A&E very agitated. On examination she has a tremor, dilated pupils, she's sweating and there are hyperactive bowel sounds. On top of this she is tachycardic with an arrhythmia noted on ECG. As you look at the ECG the patient has a convulsion.

Which of the following options is most likely to be the causative poison in this scenario?

(a) Tricyclic antidepressants

(b) Benzodiazepines

(c) Opiate analgesics

(d) Salicylates

(e) Sympathomimetics

(f) Methanol

(g) Ethylene glycol

(h) Insulin

(i) Carbon monoxide

(j) anti-psychotics

(k) Volatile solvents

The correct answer is (e) sympathomimetics. Sympathomimetic use is high in the UK, particularly amongst young adults. Symptoms are similar to tricyclic overdose except sweating and hyperactive bowel sounds are only present in a sympathomimetic toxidrome.

7

A 38 year old male with a background of depression is admitted to A&E following an overdose. He complains of a ringing in his ears, and nausea and vomiting. On examination his respiratory rate is raised, he's tachycardic, there is a noted level of deafness and he's sweating profusely.

Which of the following options is most likely to be the causative poison in this scenario?

(a) Tricyclic antidepressants

(b) Benzodiazepines

(c) Opiate analgesics

(d) Salicylates

(e) Sympathomimetics

(f) Methanol

(g) Ethylene glycol

(h) Insulin

(i) Carbon monoxide

(j) anti-psychotics

(k) Volatile solvents

The correct answer is (d) Salicylates. Tinnitus is almost pathognomonic of salicylate poisoning. Deafness and tinnitus may persist despite prompt and correct treatment of the overdose.

8

An angry old consultant rails of a list of inebriation, reduced reflexes, tachycardia, pulmonary oedema, shock and metabolic acidosis and asks you "ingestion of what would cause these symptoms"?

Which of the following options is most likely to be the causative poison in this scenario?

(a) Tricyclic antidepressants

(b) Benzodiazepines

(c) Opiate analgesics

(d) Salicylates

(e) Sympathomimetics

(f) Methanol

(g) Ethylene glycol

(h) Insulin

(i) Carbon monoxide

(j) anti-psychotics

(k) Volatile solvents

The correct answer is (g) ethylene glycol. Mean question by the old codger, perhaps to be expected, because methanol, ethanol and ethylene glycol all produce differing degrees of inebriation, hyporeflexia and coma. The presence of pulmonary oedema, shock and acidosis is more specific for ethylene glycol poisoning.

9

Drowsiness, hypotension, hypoventilation, arrythmias, convulsion, dystonia and dyskinesias are a collection of symptoms caused by an overdose of what?

Which of the following options is most likely to be the causative poison in this scenario?

(a) Tricyclic antidepressants

(b) Benzodiazepines

(c) Opiate analgesics

(d) Salicylates

(e) Sympathomimetics

(f) Methanol

(g) Ethylene glycol

(h) Insulin

(i) Carbon monoxide

(j) anti-psychotics

(k) Volatile solvents

The correct answer is (j) anti-psychotics. Neuroleptic agents (e.g. phenothiazines such as chlorpromazine) cause CNS depression in overdose, dystonia and dyskinesias are adverse effects that may occur in therapeutic doses.

10

Increased muscle tone and reflexes, dry skin, myoclonus, convulsions, tachycardia and dilated pupils are signs and symptoms of overdose on what drug?

Which of the following options is most likely to be the causative poison in this scenario?

(a) Tricyclic antidepressants

(b) Benzodiazepines

(c) Opiate analgesics

(d) Salicylates

(e) Sympathomimetics

(f) Methanol

(g) Ethylene glycol

(h) Insulin

(i) Carbon monoxide

(j) anti-psychotics

(k) Volatile solvents

The correct answer is (a) Tricyclic antidepressants. Tricyclic antidepressants are potentially dangerous in overdose which is why they have been largely overtaken by the safer SSRIs. The most significant problems are convulsions and arrhythmias. Convulsions are treated in the usual fashion, arrhythmias often respond to deliberate alkalinisation. Sodium bicarbonate is given until the pH is around 7.5.

11

Name three drugs that can contribute to drug-induced jaundice?

Three mechanisms of drug-induced jaundice:

Haemolysis => Antimalarials e.g. Dapsone

Hepatitis => Paracetamol overdose, TB treatment (Isoniazid, ethambutol and rifampicin), valproate, statins, MOA inhibitors

Cholestasis => Flucloxacillin (may be weeks after treatment), co-amoxiclav, oral contraceptive pill, sulphonylureas, chlorpromazine, prochlorperazine.

12

Name a carbonic anhydrase inhibitor.

What is its MoA?

What is it's effect on the kidneys?

What is it used for?

Side effects?

Acetazolamide

Inhibits carbonic anhydrase in proximal collecting tubule

Effect is reduced HCO3 reabsorption, causes a small increase in Na loss

Used in glaucoma

Side effects include drowsiness, renal stones and metabolic acidosis.

13

Name a Loop diuretic.

What is its MoA?

What is it's effect on the kidneys?

What is it used for?

Side effects?

Furosemide or bumetanide

MoA is inhibition of the Na/K/2Cl sympoter in thick ascending limb of loop of henle.

The effect of this is massive NaCl, Ca and K excretion.

Used in treatment of oedema - congestic cardiac failure, nephrotic syndrome, or in hypercalcaemia.

Side effects are hypo - (Na, K, Ca) hypokalaemia can lead to metabolic alkalosis, ototoxicity and hypovolaemia.

14

Name a Thiazide diuretic.

What is its MoA?

What is it's effect on the kidneys?

What is it used for?

Side effects?

Bendroflumethiazide. (Metolozone has the same MoA but is NOT a thiazide diuretic)

MoA is it inhibits NaCl co-transporter in distal collecting tubule.

Effect is moderate NaCl excretion and increased Ca reabsorption.

Used in hypertension, helps reduce renal stones, and can be used for mild oedema.

Side effects, hypokalaemia (excretion of Na), hyperglycaemia, increased urate (contraindicated in gout).

15

Name a potassium sparing diuretic.

What is its MoA?

What is it's effect on the kidneys?

What is it used for?

Side effects?

Spironolactone, amiloride.

Spironolactone is an aldosterone antagonist, amiloride blocked distal convoluted tubule/collecting duct's luminal Na channel.

Effect is increased Na excretion and decreased potassium and hydrogen excretion.

Used with loop or thiazide diuretics to control potassium loss, spironolactone has long term benefits in aldosteronism (liver failure, heart failure)

Side effects: increased potassium/hyperkalaemia, anti-androgenic (gynaecomastia)

16

Name an osmotic diuretic

What is its MoA?

What is it's effect on the kidneys?

What is it used for?

Side effects?

Mannitol

Mechanism of action is that it's freely filtered and poorly reabsorbed (so essentially just sits in the plasma as an osmotic agent and is filtered easily out by kidneys)

Effect is reduced brain volume and decrease in intracranial pressure.

Use in glaucoma, raised ICP and rhabdomyolosis

Side effects are hyponatraemia, pulmonary oedema and nausea and vomiting.

17