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MRCP 1 > Pharma/Tox > Flashcards

Pharma/Tox Flashcards

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1
Q

Mechanism of action of bisphosphonates

A

Inhibits osteoclastic activity

Note: no effect on osteoblastic activity

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2
Q

Treatment of beta blocker overdose

A

1st line atropine

2nd line glucagon

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3
Q

Side effects of acetazolamide

A

MOA: inhibition of carbonic anhydrase

Metabolic acidosis (due to bicarb loss in the proximal and distal tubules, by inhibiting reabsorption)
HypoNa
Acute interstitial nephritis
Agranulocytosis and thrombocytopenia

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4
Q

Deafness is a recognised complication of aspirin overdose T/F

A

True

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5
Q

Management of aspirin overdose?

A

Gastric lavage up to 4 hours. Activated charcoal for sustained-release preperations
Plot level at 6 hours on normogram
Alkalisation of urine to aid drug excretion, close monitoring of electrolytes and pH , electrolyte repletion

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6
Q

In aspirin overdose hypoventilation is common T/F

A

False - tachypnea is common.
Note: Phase 1 tachypnea directly stimulates the resp center -> resp alkalosis with a compensatory alkaline urine with bicarb and potassium loss

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7
Q

Aspirin overdose is associated with hypoK and hyopglycaemia T/F

A

True

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8
Q

When is activated charcoal indicated in treatment of paracetamol OD?

A

If >150mg/kg taken + presentation <1 hr since ingestion

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9
Q

Melatonin is primarily metabolised in the kidney T/F

A

F - primarily met in the liver, hence can build up in those with hepatic impairment

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10
Q

The MOA of melatonin is due to binding to MT1 and MT2 receptors T/F

A

True

Note: MT1 is in the suprachiasmatic nucleus of the ant hypothalamus and MT2 is in the retina

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11
Q

Melatonin is C/I in those with epilepsy T/F

A

F - used to be thought to lower sz threshold but that was a poor study

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12
Q

Where is digoxin eliminated?

A

70% is excreted unchanged in the urine

NB: in patients with CKD they should be treated with a decreased loading dose and decreased maintenance dose

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13
Q

Patients on co trimoxazole need to be monitored for what serious (but rare) side effect?

A

Cholestatic jaundice

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14
Q

Code dose adrenaline?

A

0.1mg/kg 1:10,000

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15
Q

What is the most common adverse effect of theophylline overdose?

A

Arrhythmia (it is a phosphodiesterase inhibitor but also acts on adenosine receptors such as on the AV node)

Note: other adverse effects agitation, restlessness or seizure

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16
Q

What is the initial treatment of a TCA overdose?

A

IV sodium bicarbonate

Note: leads to QRS prolongation and possible tachyarhythmias due to Na channel blocking in the myocardium. Na bicarb increases TCA protein binding, dislodges TCA from the Na channel and increased TCA elimination. TCA OD renders the myocardium relatively insensitive to tradition antiarrhythmics.

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17
Q

What class of antidepressant is associated with GI bleeds?

A

SSRI

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18
Q

Doses in adrenaline pens for anaphylaxis?

A

EpiPen Jr 0.15mg (< 6yrs)
EpiPen 0.3mg (6-12 yrs)
IM adrenaline 0.5mg ( >12 yrs)

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19
Q

Indication for activated charcoal in drug overdose?

A

Within 1 hr of ingestion in a conscious patient (N +V are common post treatment so want to avoid in those with altered level of consciousness)

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20
Q

Trimethoprim can cause an elevation in urea and Cr T/F

A

F - only causes elevation in Cr. It completes with Cr for secretion into the renal tubules so causes asymptomatic elevation in serum Cr with no change in urea. This is not true renal injury

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21
Q

Where does cyclizine work?

A

Medulla oblongata

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22
Q

Beta blockers can cause difficulty sleeping/insomnia T/F

A

True

Can also cause hypoglycaemia

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23
Q

Side effect of prostaglandin

A

Apneoa

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24
Q

Treatment of hereditary angio-edema?

A

C1 inhibitor or kallikrein inhibitor ecallantide

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25
Where does methylphenidate work?
Basal ganglia - inhibition of dopamine reuptake
26
Rifampicin reduces the levels of statin T/F
T Clarithromycin increases the levels of statins
27
Antibiotic that increased the levels of statins?
Clarithromycin
28
Steroids are CI in the treatment of TB meningitis T/F
F - they are an adjunct to treatment with triple antiTB therapy
29
Mechanism of action of ipratropium bromide?
Anti muscarine bronchodilator SE: mydriasis (dilated pupils), skin flushing, hyperthermia, dry skin and mouth, urinary retention and agitation
30
Usual stat tx dose of oral dex in croup tx?
0.15mg/kg
31
In patients with renal impairment the loading dose of drugs needs to be decreased T/F
F - loading doses remain unchanged - loading doses are related to the volume of distribution which remains unchanged.
32
Conversion of oral morphine to subcut diamorphine and subcut morphine?
10mg oral morphine = 3mg diamorphine 10mg oral morphine = 5mg subcut morphine
33
In the tx of allergic rhinitis when is an oral antihistamine 1st line (instead of intranasal)
Oral is first line if: - pt 2-5 yrs - preference to take oral - conjunctivitis is also present
34
What is the MOA of baclofen?
Agonist of GABA beta receptor
35
What is the MOA of benzos?
Increase the potency of GABA at the GABA alpha receptors (AKA +ve allosteric modulator of GABA alpha receptor)
36
What medications should be avoid in those with Juvenile myoclonic epilepsy?
Carbamazepine Phenytoin Oxcarbazepine They can aggravate the sz Note: sleep deprivation and alcohol consumption can precipitate the sz; EEG will show periodic 3Hz spikes
37
What is considered a staggered dose of paracetamol? How does this impact treatment?
Staggered dose is any dose taken over longer than an hour. At greater than an hour the normogram cannot be used and hence if there is concern that a person has ingested a significant amount they should just be treated with NAC
38
What is the best steroid to use in a pt who already has HTN?
Dexamethasone - has little to no mineralocorticoid activity Note: methylpred and pred have significant mineralocorticoid activity
39
What is a Type A drug reaction?
"Augmented" - eg hypotension with a beta blocker or hypoglycaemia with insulin
40
What is a Type B drug reaction?
"Bizarre" - anaphylaxis
41
What is a Type C drug reaction?
"Continued" - lasts for a long time, eg visual field defects with vigabatrin
42
What is a Type D drug reaction?
"Delayed" - eg neutropenia with chemo
43
What is a Type E drug reaction?
"End of use" - withdrawal symptoms
44
MOA of beta lactams?
Inhibition cell wall synthesis Vancomycin also works in this way
45
MOA of colistin (a polymyxin)
Disrupts cell membrane integrity
46
MOA of co-trimoxazole ?
Inhibition of folate synthesis
47
MOA of quinolones?
Inhibition of mRNA synthesis (eg ciprofloxacin)
48
MOA of aminoglycosides?
Inhibition of protein synthesis by binding to 30s ribosome subunit
49
Antidote to unfractionated heparin?
Protamine Note: it has limited utility against LMWH
50
How many half lives are needed for the drug to be mostly cleared?
5
51
Side effects of montelukast?
Common: GI upset and rash Rare: can precipitate Churg Strauss syndrome (can present with worsening asthma, neuropathy and a peripheral eosinophilia)
52
When should a digoxin level be checked?
Anytime more than 6 hours post dose.
53
What antibiotics are C/I in those with myasthenia gravis?
Aminoglycosides (such as gentamicin or amikacin) as they cause blockade of the NMJ and can exacerbate the condition
54
What is the preferred opioid to be used for analgesia in a syringe driver?
Diamorphine - it has a high solubility that allows a large dose to be given in a small volume (hence more practical than morphine)
55
Inhibition of hypoxanthine-guanine phosphoribosyltransferase what drug?
Mercaptopurine
56
Which antibiotics are most strongly associated with c dif/pseudomembranous colitis?
Cephalosporins ( eg cephalexin, cefuroxime) is strong | Also common with clindamycin, ampicillin and amoxicillin
57
How does acute Vit A toxicity present?
Signs of raised ICP
58
Vincristine can have neurotoxicity side effects T/F
True - these can manifest as mobility issues, limb or back pain or cranial nerve neuropathies Can also cause constipation, change in sensation, headaches
59
What type of drug is levomepromazine?
Antiemetic Note: drowsiness is a side effect
60
Which is a stronger steroid HCT or prednisolone? How to convert HCT to pred
Prednisolone Pred dose is 25% of the total dose of HCT. eg if on 25mg HCT this would be 25mg/4.
61
TB medication that can cause seizures in infant?
Isoniazid
62
Hoarse voice is a side effect of inhaled steroid use T/F
T - they deposit in the vocal cords leading to change in timbre
63
Coma is a feature of severe salicylate overdose T/F
F - can cause delirium or confusion but not typically coma
64
Sweating is a feature of salicylate overdose T/F
T - can interfere with the CNS autonomic function and increase basal metabolic rate leading to sweating
65
Common side effect of Efavirenz?
Depression (in those with no prior history of mental health problems) Note: Rilpivirine can cause depression too but it is more likely in those which a hx of mental health problems
66
Common side effect of Rilpivirine?
Depression (more likely in those which a hx of mental health problems)
67
Most common side effect of Emtricitabine?
Rash and darkening of palms and sole
68
What lab abnormality does Cimetidine cause?
Elevation of creatinine without changing real GFR
69
What is the mechanism of cough due to ACE inhibitors?
Increased bradykinin
70
When given IV cotrimoxazole should be given as a slow IV bolus or an infusion?
As an infusion, preparation is very alkaline and hence can be caustic if given as a bolus Note: although preferable to give via a central line can be given via a peripheral if it is diluted enough
71
Gentamycin gram + or gram -ve coverage?
Gram -ve only
72
Typical anticholinergic side effects?
Tachycardia Pupil dilatation (mydriasis) Dry mucus membranes Urinary retention
73
HypoNa is MDMA ingestion can be due to SIADH
True - can also be due to excessive fluid intake
74
HypoNa is the most common cause of death in MDMA overdose T/F
F - arrhythmia is most common
75
What are indications for hyperbaric O2 in carbon monoxide poisoning?
1. CV dysfxn 2. Pregnant (esp if carboxyHb >10%) 3. CarboxyHb > 20% 4. Unconscious / episode of syncope 5. Neuro/psych features (excluding HA)
76
Is bradycardia a characteristic feature of opioid overdose?
Yes
77
2 drugs that can cause hyperventilation in overdose?
Theophyline | Salicylates
78
LSD is associated with serotonin syndrome T/F
F - LSD is not Note: MDMA is assoc with serotonin syndrome
79
Typical features of serotonin syndrome?
``` Sweating Agitation Tachycardia Dilated pupils Muscle rigidity In severe cases: seizures, clonus ```
80
Mechanism of action of loop diuretic is on the Na-K-Cl co transporter or the Na-Cl symporter
Na-K-Cl co transporter
81
Mechanism of action of thiazide diuretic is on the Na-K-Cl co transporter or the Na-Cl symporter
Na-Cl symporter
82
Seizures occur in about 50% of patients presenting with an NSAID overdose T/F
F - occurs in about 10-20%. It is more common in patients who have taken mefenamic acid
83
What are the main side effects of NSAID overdose?
Common: mild GI - epigastric tenderness, nausea, emesis and diarrhoea (due to inhibition of cycle-oxygenase mostly) Large overdoses can also have drowsiness, coma , cerebellar signs and seizures. AKI and cardiorespiratory arrest, hypothrombinaemia
84
Desferrioxamine IV is a chelator used for what type of poisoning?
Significant iron overdose
85
Common side effects of cyclosporin?
Chronic interstitial nephritis Hypertrichosis Gum hypertrophy Note: phenytoin also causes gum hypertrophy
86
In a patient starting on MTX NSAIDs use should be avoided, why?
NSAIDs can result in AKI or just mildly decreased kidney function. MTX relies on renal excretion and hence even a small decrease in kidney function can result in increased toxicity
87
In terms of teratogenic effects thalidomide causes phocomelia T/F
T - aka abnormalities of the limbs
88
What drug is known to cause chondrodysplasia punctata in the foetus?
Warfarin - these are skeletal abnormalities with punctate calcification of the cartilage of the epiphyses, larynx and trachea
89
What is the MOA of bosentan?
Endothelin receptor antagonist Nore: endothelin is a potent vasoconstrictor, it is a polypeptide
90
What TB drug is known to cause red/orange discolouration of bodily fluids?
Rifampacin
91
What HIV medications are closely associated with fat loss/lipoatrophy?
Zidovudine, stavudine (nucleoside RTIs)
92
How should amiodarone be administered to a neonate
IV (ideally via a central line) diluted in 5% glucose Note: it is incompatible with NaCl ; needs to be diluted as it is alkaline and can cause pain and inflammation on infusion if not Oral abs in the neonatal period is unpredictable and in general abs is very slow
93
What labs are the best markers of severity in paracetamol overdose?
INR pH Serum Creatinine
94
What is the mechanism of action of terlipressin?
Vasopressin analogue - hence causes vasoconstriction of the splanchnic blood vessels.
95
What is the mechanism of action of activated charcoal in treatment of drug overdose?
Interrupts a drug's enterohepatic circulation
96
What is the main reaction involved in the normal metabolism of paracetamol?
Glucuronidation Note: when this pathway becomes overwhelmed in overdose cyto p450 pathway is used
97
What is the appropriate mgmt of a patient with an elevated gent trough and why?
``` trough = renal clearance peak = drug dose ``` --> keep dosing the same but less often so as to allow drug to still reach therapeutic peak and also give enough time to clear
98
What is a good inotrope to use if you do not want to increase HR?
Phenylephrine as it is purely alpha adrenergic and hence raises BP without effect on HR
99
What is the mechanism of action of dobutamine?
Pure beta 1 adrenergic --> increases HR and force of contraction Note: good for cardiogenic shock
100
Why should codeine be used with caution in those < 6 yrs old/avoided if possible?
It metabolises v quickly to morphine
101
Which atypical antipsychotic has particularly high likelihood to cause the side effect of hyperprolactinaemia?
Risperidone
102
Statins block de novo cholesterol synthesis T/F
T - hmg CoA reductase inhibitor
103
What is the MOA of sildenafil?
Inhibits breakdown of cGMP (guanosine monophosphate) --> increasing cGMP
104
How does glucagon function in treatment of beta blocker overdose?
Increases cAMP (adenosine monophosphate) by direct stimulation of adenylate cyclase in the cardiac mycytes --> increasing rate and force of cardiac contraction Note: mode of action is independent of the blocked beta receptors
105
What is the MOA of aminophylline and theophylline?
Phosphodiesterase inhibitor and adenosine antagonist
106
Leucopenia is a side effect of lithium T/F
F - leucocytosis
107
Leucocytosis is a side effect of lithium T/F
T
108
Acetazolamide can cause what acid base abnormality?
Met acidosis Note: loop, thiazides cause alkalosis
109
Paracetamol is a non selective inhibitor of COX1 and 2 enzymes. T/F
F - inhibits cox 1 --> resulting in reduced prostaglandin synthesis
110
Dosing of mannitol and hypertonic saline for treatment of cerebral oedema
Mannitol 1g/kg (20%) 2.5 -5ml/kg hypertonic saline Both over 10-15 minutes
111
On what cells do PPIs work?
Parietal cells Blocks the H/K ATP pump
112
Where does mannitol act?
Entire loop of henle
113
For a child weighing 35kg the dose of NAC is 150mg/kg in 100ml 5% glucose T/F
T - for a child weighing 20-39kg this is the dose
114
For a child weighing 10kg what is the dose of NAC
150mg/kg in 3ml 5% glucose This is the dose for a child < 20 kg
115
For a child weighing 45kg the dose of NAC is 150mg/kg in 100ml 5% glucose T/F
F - the NAC should be in 200ml, this is the dosing for anyone > 40kg (adult dosing)
116
NAC works in paracetamol overdose by reducing the formation or the circulation of toxic metabolites?
It reduces the circulation
117
Gum hypertrophy is a side effect of nifedipine T/F
T

MRCP 1 (21 decks)

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