misc cards

Question 1

Transaminases- ALT, AST

Answer 1

Found in hepatocytes and released from them when they are damaged
ALT more liver specific

Question 2

Alkaline Phosphatase (ALP)

Answer 2

Isoenzyme released from different parts of the body- not liver specific- increased in biliary tract damage, cholestasis, obstruction

Question 3

Gamma-glutamyl transferase (GGT)

Answer 3

Found in hepatocytes and biliary tract
Non specific
If increased with ALP= cholestasis
Increased by alcohol/enzyme inducing drugs

Question 4

Bilirubin

Answer 4

Breakdown product of RBC normally excreted in bile
Increased in haemolysis, cholestasis and hepatocellular damage

Question 5

Albumin

Answer 5

Marker of synthetic liver capacity
Long half life, affected by nutrition/hydration state
Good marker of chronic liver disease

Question 6

Prothrombin Time (PT)

Answer 6

Synthetic ability of clot to form
Increased by; vit K deficiency, acute/chronic liver disease

Question 7

Acute liver disease onset

Answer 7

<6months

Question 8

Causes of acute liver disease

Answer 8

Acute viral hepatitis
Paracetamol overdose

Question 9

Chronic liver disease causes

Answer 9

Alcoholic liver disease
Viral infections
NAFLD
Vascular abnormalities
Hepatitis

Question 10

Complications of chronic liver disease

Answer 10

Ascites, portal hypertension, varices, hepatic encephalopathy

Question 11

Ascites

Answer 11

accumulation of fluid in the peritoneal cavity causing abdomen to swell
Excess Na

Question 12

Ascites management

Answer 12

paracentesis
Spironolactone up to 400mg/day
Loop diuretics

Question 13

Portal hypertension

Answer 13

Increased blood pressure in the portal venous system.

Question 14

Varices

Answer 14

Abnormally dilated collateral vessels in stomach or oesophagus due to portal hypertension

Question 15

Prevention of varices

Answer 15

Carvedilol 3.125-12.5mg

Question 16

Hepatic encephalopathy

Answer 16

Reversible spectrum of neuropsychiatric change due to ammonia accumulation in the brain potentially due to increased BBB permeability
Liver unable to clear ammonia

Question 17

Prevention of hepatic encephalopathy

Answer 17

Lactulose at high doses
Rifaximin
L-ornithine-L-aspartate sachets

Question 18

Drugs to treat hyperkalaemia

Answer 18

Calcium resonium
Salbutamol nebules
Insulin/dextrose
Sodium bicarbonate

Question 19

CKD bone mineral disease treatment

Answer 19

Diet- protein rich foods
Phosphate binders; sevelamer
Vitamin D; alfacalcidol
Cinacalcet

Question 20

Renal anemia (decreased erythropoietin= decreased RBC)

Answer 20

ESAs
HIF inhibitors- roxadustat
IV iron
Oral iron- never at same time as phosphate binders

Question 21

Infection prophylaxis in CKD

Answer 21

Valganciclovir- cytomegalovirus
Nystatin- oral thrush
Co-trimoxazole pheumocytes
Isoniazide and pyridoxine- TB

Question 22

Constipation in peritoneal dialysis

Answer 22

Senna and docusate

Question 23

Acute Kidney Infection

Answer 23

A sudden decline in kidney function overs hours to days
Incraesed urea/creatinine
Decreased urine output

Question 24

Risk factors

Answer 24

Age
Diabetes
CKD
Cardiac failure
Dehydration
Nephrotoxins
Chronic liver disease
Reduced renal BF

Question 25

Signs of AKI

Answer 25

Reduced urine output/anuria Swelling in legs, ankles, around eyes Fatigue SOB N&V Abdominal pain Dehydration and thirst Seizure or coma Confusion/drowsiness

Question 26

Stage I AKI

Answer 26

Rise in creatinine of >1.5-1.9 times baseline or increase >26umol/L within 48hrs <0.5ml/kg/hr for 6 hrs

Question 27

Stage II AKI

Answer 27

Rise in creatinine of >2-2.9 times baseline <0.5ml/kg/hr for 12 hrs

Question 28

Stage III AKI

Answer 28

Rise in creatinine of >3 times baseline or increase in creatinine of >354umol/L within 48hrs <0.3ml/kg/hr for 24hrs or anuria for 12hrs

Question 29

Types of AKI

Answer 29

Prerenal- reduced BF Renal- direct damage to kidneys Postrenal- obstruction

Question 30

Treatment of pre renal failure

Answer 30

Removal of nephrotoxin Fluids

Question 31

AKI complications

Answer 31

Fluid overload Hyperkalaemia Pulmonary oedema Uraemia Acidosis Bleeding Infection Hyperphosphataemia Hypocalcaemia

Question 32

Poorly tolerated drugs in the elderly

Answer 32

Antipsychotics NSAIDs Digoxin >250 Benzos Anticholinergics Sulfonylureas Antihypertensives Anticoagulant

Question 33

ADME changes in elderly

Answer 33

Absorption- increased gastric pH, decreased GI motility/BF Distribution- decreased lean body mass, body water, albumin, increased body fat Metabolism- reduced first pass, liver BF, size and mass, CYP450 Elimination- decreased kidney size, renal BP, functional nephrons, tubular secretion- decreased GFR

Question 34

Biological processes that underline ADRs

Answer 34

CYP450 Human leukocyte antigens Drug transporters

Question 35

DPYD gene in fluoropyrimidine chemotherapy

Answer 35

DPYD gene encodes enzyme which breaks down drug so toxic levels

Question 36

HIV patients tolerability to abacavir

Answer 36

AHS (abacavir hypersensitivity syndrome) associated with HLA-B* 57:01

Question 37

Carbamazepine adverse effects from HLA-A*15:02

Answer 37

Associated with hypersensitivity particularly in SE populations

Question 38

Clopidogrel and CYP2C19 gene

Answer 38

Prodrug processed by CYP2C19 gene into active form- those with genetic variations at risk of stroke

Question 39

ADME changes in paediatrics

Answer 39

Absorption- shorter intestinal transit, gastric pH neutral at birth (normal 2yrs), bile secretion poor weeks 1-3, intestinal permeability high at birth with progession reduction during first week of life Distribution- increased V of lipophilic drugs vs older children and hydrophilic drugs in preschool children, decreased plasma protein conc so increased free drug Metabolism- increased hepatic cl in infants/preschool children as increased liver BF, different enzyme expression/ activity Excretion- GFR lower- low renal cl

Question 40

Analgesia in critical care

Answer 40

Alfentanil, remifentanil, fentanyl, morphine

Question 41

Indications for muscle relaxants

Answer 41

Critical gas exchange ICP control Multiple trauma

Question 42

Examples of muscle relaxants

Answer 42

Atracurium, rocuronium, cisatracurium