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Pharmacology Flashcards

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1
Q

Which drugs cause impaired glucose tolerance?

A

TASTINg Sugar (impaired glucose tolerance)

Thiazides
Antiphychotics
Steroids
T cell in inhibitors (tacrolimus |&| cyclosporin)
Interferon alpha
Nicotinic acid (niacin N3)
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2
Q

What is the MOA of aspirin?

A

IRreversible inhibition of COX 1 and 2

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3
Q

What does aspirin increase the bodies reaction to? (three other drugs)

A

oral hypoglycaemics
warfarin
steroids

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4
Q

Tx of cyanide poisoning?

A

B12 (binds to cyanide to stop it being dangerous)

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5
Q

In paracetamol OD, what marker after 24hrs would make you consider the patient for a liver transplant?

A

An arterial pH <7.3, 24 hours after ingestion

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6
Q

How ‘staggered’ qualifies a staggered OD?

A

an overdose is considered staggered if all the tablets were not taken within 1 hour

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7
Q

What is the MOA of metformin?

A

activation of the AMP-activated protein kinase (AMPK)

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8
Q

What class of medication is metformin in?

A

Biguanides

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9
Q

What is the MOA of HIT?

A

antibodies form against complexes of platelet factor 4 (PF4) and heparin

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10
Q

What is the MOA of allopurinol?

A

AllopurINol = INhibits Xanthine Oxidase

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11
Q

Main troublesome SE of Mg?

A

Diarrhoea

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12
Q

Causes of low Mg?

A

HypoMAGNesia

M = metabolic: Gitelmans + Bartters
A = alcohol
G = gut: diarrhoea
N = nutrition: TPN

Also drugs: thiazides
Electrolytes: hypoK, hyperCa

MAGNet
E = electrolytes
T = thiazides/loop/PPIs

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13
Q

Patients at a high risk of severe cutaneous adverse reaction should be screened for what allele?

A

the HLA-B *5801 allele

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14
Q

What do you need to be careful of co-prescribing with allopurinol and why?

A

Azathioprine
Because azathioprine breaks down into the active compound 6-mercaptopurine. This is usually further broken down by Xanthine Oxidase. Therefore when allopurinol stops XO working it can lead to v high levels of 6-mercaptopurine.

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15
Q

What other drugs need careful co-prescribing with allopurinol?

A

Cyclophosphamide
allopurinol reduces renal clearance, therefore may cause marrow toxicity

Theophylline
allopurinol causes an increase in plasma concentration of theophylline by inhibiting its breakdown

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16
Q

SEs of quinolones?

A 
Tendon damage
Lengthens QT (think stomachs Ea)
LOWERS the seizure threshold in epilepsy
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17
Q

CIs for quinolones?

A

Pregnancy + G6PD

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18
Q

Lithium therapeutic range?

A

0.4-1

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19
Q

What can precipitate lithium toxicity?

A

Not diluted: dehydration
Not excreted: renal failure
drugs: diuretics (especially thiazides), ACEi/ARBs, NSAIDs and metronidazole

Same DAMN drugs are nephrotoxic but with metro rather than metformin

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20
Q

SEs of lithium use and signs of toxicity?

A 
SE:
Nausea
Fine tremor
Weight gain + oedema
Polydipsia + polyuria
Hypothyroidism

Toxicity:
Vomiting
Coarse tremor
Diarrhoea
Slurred speech/ataxia/confusion
Convulsions/coma
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21
Q

Treatment of lithium toxicity?

A

IV fluids
Haemodialysis in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this

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22
Q

What are the effects of excessive Ach?

A 
DUMBELS
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweating
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23
Q

Management of organophosphate poisoning?

A

Atropine

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24
Q

What is the MOA of sodium bicarb in Tx of lithium toxicity?

A

Increases urine alkalinity

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25
When is quinine given if not for its antimalarial properties?
Leg cramps
26
4 hallmark symptoms and two effects of quinine overdose?
Hallmarks are tinnitus, visual blurring (think retinopathy), flushed and dry skin and abdominal pain Effects: cardiac arrhythmias, hypoglycaemia
27
Name of quinine OD?
Cinchonism
28
Adverse effects of ciclosporin?
``` (note how everything is increased - fluid, BP, K+, hair, gums, glucose) nephrotoxicity hepatotoxicity fluid retention HTN hyperkalaemia hypertrichosis gingival hyperplasia tremor impaired glucose tolerance hyperlipidaemia increased susceptibility to severe infection ```
29
How to treat adrenaline induced ischaemia e.g. epipen to the hand?
Adrenaline induced ischaemia - phentolamine (alpha antagonist)
30
How to remember the general classes of anti-arrhythmic drugs?
``` Son of a B*tch is Politically Correct 1 Sodium blocker 2 Beta blocker 3 Potassium blocker 4 calcium blocker ```
31
How to remember the class 1 anti-arrythmics?
Double Quarter Pounder with Tomato Lettuce Mayo, also Fries Please Disopyramide Quinidine Procainamide(Ia)/ Tocainide Lidocaine Mexilitine(Ib)/ Flecainide Propafenone (Ic)
32
Drugs that are CI in pregnancy?
CATS CRAWSS ``` Abs: Quinolones (ciprofloxacin) Aminoglycosides - Ototoxicity Tetracyclines - Discoloured teeth Sulphonamides + trimethoprim ``` ``` Cytotoxic agents Retinoids (topical + PO) ACEi/ARBs - renal dysgenesis/CF abnormalities Warfarin - CF abnormalities Statins Sulfonylureas ```
33
What is the MOA of cocaine?
cocaine blocks the uptake of dopamine, noradrenaline and serotonin
34
SEs of cocaine use?
Cocaine - Eric Clapton E - Elevated BP R - Rhabdomyolysis I - Ischaemic Collitis C - Coronary vasospasm ``` C - convulsions L - long QT and QRS A - Aortic dissection P - Psychosis Ton - Tone (increases) / reflexes (increases) ```
35
Management of cocaine OD? With CP? with HTN?
Benzodiazepines CP - GTN spray HTN - Na nitroprusside
36
MOA of cyclosporin/tacrolimus?
Ciclosporin + tacrolimus: inhibit calcineurin thus decreasing IL-2
37
What is the MOA of cyanide?
Cyanide inhibits the enzyme cytochrome c oxidase, resulting in cessation of the mitochondrial electron transfer chain. Think all 'c's
38
Causes of drug induced photosensitivity?
``` SEE - ciprofloxacin H - hypoglycaemics - sulphonylureas (i) S - sulphonamides T - tetracyclines, thiazides A - amiodarone N - NSAIDs e.g. piroxicam ```
39
What would you try if metformin can't be tolerated in T2 DM?
MR metformin
40
Two examples of drugs that work on nuclear receptors?
Prednisolone | Levothyroxine
41
Drugs which can be cleared with haemodialysis?
BLAST ``` Barbiturate Lithium Alcohol (inc methanol, ethylene glycol) Salicylates Theophyllines (charcoal haemoperfusion is preferable) ```
42
What problem in the kidneys can aminoglycosides cause?
Acute tubular necrosis
43
How quickly can you titrate metformin?
Earliest one week d/t risk of diarrhoea
44
Treatment for tricyclic OD?
Bicarbonates
45
TCA OD symptoms?
Anticholinergic: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision, urinary retention Features of severe poisoning include: arrhythmias (can cause prolonged QT/VT) seizures + coma
46
Drugs causing ocular problems? | Cataracts/corneal opacities/optic neuritis/retinopathy
``` Cataracts: steroids Corneal opacities: amiodarone, indomethacin Optic neuritis: ethambutol amiodarone metronidazole Retinopathy: chloroquine, quinine ```
47
SEs of TB drugs?
Rifampicin -> Orange bodily fluids, rash, hepatotoxicity, drug interactions Isoniazid -> Peripheral neuropathy, psychosis, hepatotoxicity Pyrazinamide -> Arthralgia, gout, hepatotoxicity, nausea Ethambutol -> Optic neuritis, rash RIP: Liver
48
Drugs causing urticarial rash?
``` NAPPY Nsaid Aspirin Penicillin o(PY)iates ```
49
What may be protective if taken with a paracetamol OD?
Acute alcohol intake
50
What increases the toxic effect of paracetamol (drugs)?
liver enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St John's Wort)
51
Drug induced thrombocytopaenia?
``` QANADAH quinine abciximab NSAIDs diuretics: furosemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate heparin ```
52
Common drugs to cause DRESS syndrome?
ALLOPURINOL, anti-epileptics, antibiotics, immunosuppressants, HIV treatment and NSAIDS
53
Symptoms of DRESS syndrome?
extensive skin rash, high fever, and organ involvement, supported by a finding of eosinophilia and abnormal liver function tests
54
What does DRESS mean?
drug reaction with eosinophilia and systemic symptoms
55
Drugs that may precipitate an attack of acute intermittent porphyria?
``` She Has Belly Aches Because Of porphyria: Sulphonamides Halothane Barbiturates Alcohol Benzodiazepines OCP ```
56
When to take therapeutic drug levels for lithium, ciclosporin, digoxin and phenytoin?
Phenytoin + ciclosporin - just before dose Digoxin - 6hrs post-dose Lithium - 12hrs post-dose i have a Date @ 6, so i will be Late @ 12. Call before you check and PHone if in doubt.
57
SEs of verapamil?
``` Heart failure Ankle swelling Flushing Headaches CONSTIPATION ```
58
How to treat acute dystonic reactions e.g. oculogyric crisis?
benztropine or procyclidine
59
What is Ethylene glycol?
Antifreeze
60
Features of antifreeze poisoning?
Stage 1: symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness Stage 2: metabolic acidosis with high anion gap and high osmolar gap. Also tachycardia, hypertension Stage 3: acute kidney injury
61
Management of ethylene glycol poisoning?
Fomepizole
62
MOA of fomepizole?
competitive inhibition of alcohol dehydrogenase
63
Other than acidosis, what three factors are needed for liver transplant consideration following paracetamol OD?
All of the following: prothrombin time > 100 seconds creatinine > 300 µmol/l grade III or IV encephalopathy
64
Which one of the following enzymes is involved in phase I drug metabolism?
Alcohol dehydrogenase
65
Macrolide SEs?
prolongation of the QT interval GI side-effects are common. Nausea is less with clarithromycin than erythromycin cholestatic jaundice: risk may be reduced if erythromycin stearate is used P450 inhibitor azithromycin is associated with hearing loss and tinnitus
66
Drugs that cause photosensitivity?
SEE (C) HiS TAN ``` cipro hypoglycaemics - sulphonylureas sulphonamides tetracylines, thiazides amiodarone nsaids ```
67
Which two medications can be given to prevent alcohol ingestion in alcoholics?
Acamprosate - decreases cravings Disulfiram - blocks alc metabolism which induces an accumulation of acetaldehyde leading to headaches, flushing and nausea aCam - cravings diSul - sick
68
What is the MOA of benzos?
ENHANCE the effect of the INHibitory GABA neurotransmitter by increasing the FREQUENCY of chloride channels
69
How do you withdraw benzos if people are dependent on them?
steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight
70
What is the MOA of Metoclopramide and Domperidone?
Dopamine receptor ANtagonists
71
Adverse effects of dopamine agonists?
nausea/vomiting postural hypotension hallucinations daytime somnolence
72
Which electrolyte abnormalities can predispose you to digoxin toxicity?
Low pH, temp, K, magnesium, thyroid High Ca, Na ``` Think crisp packets (ie PKT) are always half-filled with air empty (ie MT) MT PKT (empty ie low) - Magnesium, Temp, pH, Potassium (k+), thyroid ``` Fizzy drinks are always full (or high) and come in a CaN CaN - Calcium and Sodium (Na)
73
Digoxin MOA?
Inhibits the Na+/K+ ATPase pump
74
Treatment of lidocaine toxicity?
IV 20% lipid emulsion
75
Possible treatment for hyperthermia linked to ecstasy use?
dantrolene may be used for hyperthermia if simple measures fail
76
How to calculate the anion gap?
[Na+] + [K+]} - {[HCO3-] + [Cl-]
77
Best anti-sickness for motion sickness?
hyoscine > cyclizine > promethazine
78
Adverse effect of octreotide?
gallstones (secondary to biliary stasis)
79
What are patients receiving CHOP chemo particularly at risk of?
Tumour lysis syndrome | Give allopurinol
80
Which antibiotics lower the seizure threshold?
Quinolones
81
What is the life-threatening dose of paracetamol?
>12g (24 tablets)
82
Ciclosporin side-effects?
everything is increased - fluid, BP, K+, hair, gums, glucose
83
Blood test to help differentiate between CO and cyanide poisoning?
Very high lactate in cyanide, not in CO
84
Antibiotics to avoid in renal failure?
tetracycline, nitrofurantoin
85
What would P450 enzyme inducers do in the event of a paracetamol overdose?
Increase the action of p450, therefore breaking down paracetamol into its toxic metabolites
86
What is the difference between T1 and T2 amiodarone induced thyrotoxicosis?
T1: Excess iodine-induced thyroid hormone synthesis Goitre Management: Carbimazole or potassium perchlorate T2: Amiodarone-related destructive thyroiditis Absent goitre Mx: Corticosteroids
87
What is MOA of tamoxifen?
Selective oEstrogen Receptor Modulator (SERM) | Acts as an oestrogen receptor antagonist and partial agonist
88
What are the adverse effects of tamoxifen?
menstrual disturbance: vaginal bleeding, amenorrhoea hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects venous thromboembolism endometrial cancer
89
What class of drug is Ondansetron in?
5-HT3 receptor antagonist
90
Name two 5HT receptor agonists?
Sumatriptan (5-HT1D) | Ergotamine (5-HT1)
91
What is the role alpha-1 receptor and example of agonists + antagonists?
Mainly post-synaptic Vasoconstriction GI SM constriction Hepatic glycogenolysis Agonist: phenylephrine Antagonist: doxazosin (alpha-1a -> tamsulosin)
92
What is the role alpha-2 receptor and example of agonists + antagonists?
Mainly pre-synaptic insulin inhibitor platelet aggregation Agonist: clonidine Antagonist: yohimbine
93
What is the role beta-1 receptor and example of agonists + antagonists?
HEART Increases HR and force Agonist: dobutamine Antagonist: atenolol
94
What is the role beta-2 receptor and example of agonists + antagonists?
LUNG + SM + SKELETAL MUSCLE Bronchodilation Vasodilation Increased muscle contractions Agonist: salbutamol
95
What is the role beta-3 receptor?
Lipolysis
96
Example of alpha 1+2 antagonist, beta 1+2 antagonist, and generalised alpha and beta antagonist?
Alpha 1+2 antagonist - phenoxybenzamine Beta 1+2 antagonist - propranolol Generalised alpha and beta antagonist - carvediolol and labetalol
97
What occurs in phase 1 drug metabolism, where, and what enzymes are involved?
Oxidation, reduction, hydrolysis p450 enzymes, alcohol dehydrogenase Usually occurs in the liver
98
What occurs in phase 2 drug metabolism and where?
Conjugation | In the liver
99
Which drugs are excreted by zero order kinetics?
Police Stop Heavy Drinkers Phenytoin Salicyclates Heparin Alcohol
100
Which drugs are affected by acetylator status?
SHIP'D ``` Sulphasalazine Hydralazine Isoniazid Procainamide Dapsone ```
101
What interacts with macrolides?
Statins -> increase risk of myopathy/rhabdomyolysis | Amiodarone -> increases QT risk
102
Drugs causing urinary retention?
``` Nice TOAD NSAIDs TCAs Opioids Anticholinergics Disopyramide ```
103
What is the general action of heparins?
Anti-thrombin 3
104
How to monitor standard heparins and LMWH?
Heparins -> APTT | LMWH -> Anti-factor Xa
105
What is the MOA of HIT?
Plts release platelet factor 4 Binds to heparin Which bind to IgGs forming an immune complex These are recognised by the FC portion of platelets and leads to both thrombosis and thrombocytopaenia
106
UKMEC3 (dis>adv) for COCP
``` >35yrs and smoking <15/day BMI >35 FH of first degree relative with VTE <45yrs Controlled HTN Immobility BRCA1 or 2 positive Current GB disease ```
107
UKMEC4 (contraindications) for COCP
``` >35yrs and smoking >15/day BMI >40 Migraine with aura Hx VTE/stroke/IHD Breastfeeding <6wks post-partum (recent change from 6m to 6w) Uncontrolled HTN Current breast Ca ```
108
COCP risk and protective factors?
RISK: IHD, VTE, stroke, breast + cervical Ca PROTECTIVE: Colorectal + ovarian + endometrial Ca, also PID

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