Pharmacology

Question 1

How does acute intermittent porphyria often present? (2)
Age

Answer 1

Abdominal and neuropsychiatric symptoms
20-40yo

Question 2

What medication promotes ETOH abstinence?
Contraindications (2)

Answer 2

Disulfram
Ischaemic heart disease, psychosis

Question 3

What is acamprosate used in? MOA

Answer 3

NMDA antagonist
Used to reduce cravings for ETOH

Question 4

Allopurinol SE

Answer 4

Dermatological e.g Steven Johnson’s, severe cutaneous adverse reaction etc

Question 5

Amiodarone SE (8)

Answer 5

Thyroid dysfunction
Corneal deposits
Pulmonary fibrosis
Liver fibrosis
Peripheral neuropathy
Slate grey appearance
Bradycardia
Long QT

Question 6

Amiodarone effect on warfarin and digoxin

Answer 6

Increases INR and digoxin levels

Question 7

P450 inhibitors
SICKFACES.COM

Answer 7

Increases levels/ toxicity/ reduces excretion

Sodium valproate/ SSRI
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol..binge drinking acute, allopurinol, amiodarone
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit juice

Question 8

P450 inducers
CRAP GPS

Answer 8

Increased breakdown, lowers levels in the blood, increases excretion

Carbemazepines, chronic
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas , St John’s wart, smoking

Question 9

Contraindications to sildenafil (3)

Answer 9

Patients taking nitrates e.g nicorandil
Hypotension
Recent stroke/ MI (wait six months)

Question 10

Sildenafil SE (6)

Answer 10

Visual disturbances (blue discolouration)
Nasal congestion
Flushing
GI effects
Headache
Priapism

Question 11

Where does spiro work?

Answer 11

Acts in the cortical collecting ducts

Question 12

What is amiloride?
Where does it work?

Answer 12

K+ sparing diuretics
Distal convoluted tubule

Question 13

Name four medications which can exacerbate heart failure

Answer 13

Pioglitazone (SE fluid retention)
Verapamil
NSAIDS/ steroids
Flecainide

Question 14

Name four drugs to avoid in renal failure

Answer 14

NSAIDs
Lithium
Metformin
Tetracycline/ nitro

Question 15

Drugs safe in CKD (4)
Abx (2)
Blood thinner (1)
Benzo

Answer 15

Erythromycin
Rifampacin
Diazepam
Warfarin

Question 16

Name three anti-epileptics that harmful in pregnancy

Answer 16

Sodium valproate
Carbamezapine
Phenytoin

Question 17

Medications not safe in pregnancy (6)

Answer 17

Warfarin
Statin
Sulfonylureas
Retinoids
ACE inhib
Tetracyclines

Question 18

Adverse effects quinolones (3)

Answer 18

Tendon damage
Lengthen QT
Lower seizure threshold

Question 19

Feature of serotonin syndrome (5)

Answer 19

Hyperreflexia
Myoclonus
Rigidity
Hyperthermia
Sweating

Question 20

SE CCB (3)

Answer 20

Headache
Flushing
Ankle oedema

Question 21

SE bendroflumethiazide (3)

Answer 21

Gout
Low potassium and sodium
Impaired glucose tolerance

Question 22

BB SE (3)

Answer 22

Cool peripheries
Impaired glucose tolerance
Bronchospasm

Question 23

Common SE
Amoxi (1)
Coamox (1)
Fluclo (1)

Answer 23

Rash
Cholestasis
Cholestasis

Question 24

Common SE
Erythro (2)
Cipro (2)
Metro (1)

Answer 24

GI upset, long QT
Seizure lower threshold, tenodinitis
Reaction with ETOH

Question 25

Common SE Doxy (1) Trimethoprim (2)

Answer 25

Photosensitivity Rashes, pruritis

Question 26

SE metformin (2)

Answer 26

GI Lactic acidosis

Question 27

Sulfonylureas SE (4)

Answer 27

Hypoglycaemia Weight gain SIADH Liver dysfunction

Question 28

Glitazones SE (4)

Answer 28

Weight gain Fluid retention Liver dysfunction Fractures

Question 29

Gliptin SE

Answer 29

Pancreatitis

Question 30

Lithium range When to take the level

Answer 30

0.4-1 12 hours post dose

Question 31

Digoxin when to check the level?

Answer 31

At least 6 hours post dose

Question 32

Phenytoin when to check the level?

Answer 32

Trough, immediately before next dose

Question 33

SE TB drugs Rifampacin (3)

Answer 33

Flu like symptoms Hepatitis Red urine

Question 34

SE TB drugs Isoniazid (3)

Answer 34

Peripheral neuropathy Agranulocytosis Hepatitis

Question 35

Pyrazinamide (3) SE TB drugs

Answer 35

Gout Arthralgia Hepatits

Question 36

SE TB drugs Ethambutol (1)

Answer 36

Optic neuritis

Question 37

What is the Yellow Card Scheme for?

Answer 37

Report adverse reactions

Question 38

SE verapamil (4)

Answer 38

Flushing Heart failure Constipation Hypotension

Question 39

Diltiazem SE (4)

Answer 39

Ankle swelling Hypotension Bradycardia Heart failure

Question 40

Features of CO poisoning (5)

Answer 40

Headache N&V Vertigo Confusion Pink skin and mucosae

Question 41

CO poisoning Ix (2) Mx (2)

Answer 41

VBG/ABG CarboxyHb levels Mx 1. High flow oxygen through non re-breathe for a minimum of 6 hours 2. Hyperbaric oxygen

Question 42

Ciclosporin Adverse effects (4)

Answer 42

Gingival hyperplasia Hypertrichosis Impaired glucose tolerance Hyperlipidemia

Question 43

Indications for ciclosporin (4)

Answer 43

Post organ transplant RA Psoriasis UC

Question 44

Neurological effects of cocaine (4)

Answer 44

Seizures Hypertonia Hyperreflexia Mydriasis

Question 45

Mx cocaine toxicity General (1) CP (1) HTN (1)

Answer 45

Benzos CP GTN HTN sodium nitroprusside

Question 46

Diclofenac is contraindicated in (4)

Answer 46

Ischaemic heart disease PAD Cerebrovascular disease Congestive heart failure

Question 47

Digoxin toxicity When to check the level?

Answer 47

8 to 12 hours post dose

Question 48

Digoxin toxicity features (4)

Answer 48

Gynaecomastia Arrhythmias N&V, confusion Yellow green vision

Question 49

Precipitating factors for digoxin toxicity (6)

Answer 49

1. Hypokalaemia 2. Increasing age 3. Renal failure 4. MI 5. Hypomagnesium 6. High calcium and sodium

Question 50

Mx digoxin toxicity (1)

Answer 50

Digibind

Question 51

Drug monitoring Statin

Answer 51

LFTs Baseline, 3 + 12 months

Question 52

Drug monitoring ACE

Answer 52

U+E Prior to rx, after increasing dose and annually

Question 53

Drug monitoring Amiodarone

Answer 53

TFT, LFT every 6 months TFT,LFT, U+E, CXR prior to treatment

Question 54

Drug monitoring Glitazone

Answer 54

LFT Before treatment and regularly

Question 55

Drug monitoring Lithium

Answer 55

Lithium level, TFT, U+E TFT, U+E prior to treatment + every 6 months Lithium weekly until stabilised

Question 56

Drug monitoring Sodium valproate

Answer 56

LFT FBC before treatment LFT regularly during first 6 months

Question 57

Drug monitoring MTX

Answer 57

FBC, LFT, U+E Before rx started and weekly until stabilised, then every 2-3 months

Question 58

Drug monitoring AZT

Answer 58

FBC LFT before treatment and every 3 months FBC weekly for 4 weeks

Question 59

Name five drugs that can cause impaired glucose tolernace

Answer 59

Steroids Thiazides Ciclosporin Antipsychotics BB

Question 60

Drugs causing lung fibrosis (5)

Answer 60

Amiodarone MTX Sulfasalazine Bromocriptine Cabergoline

Question 60

Features of ecstasy poisoning (3)

Answer 60

Hyponatraemia Hyperthermia HTN

Question 61

Adverse effects finasteride (4)

Answer 61

Impotence Decreased libido Ejaculation disorder Gynaecomastia

Question 62

Heparin overdose can be reversed by?

Answer 62

Protamine sulphate

Question 63

Premature menopause How long should HRT be continued for?

Answer 63

Until 50yo

Question 64

Name two drugs that can cause low mag Name four other causes of low mag

Answer 64

Diuretics PPIs ETOH Diarrhoea Low K+ High calcium

Question 64

paraesthesia tetany seizures arrhythmias decreased PTH secretion → hypocalcaemia ECG features similar to those of hypokalaemia exacerbates digoxin toxicity =

Answer 64

Hypomagnesiumia (similar to low calcium)

Question 65

When to give IV mag replacement versus PO

Answer 65

<0.4 IV 40mmol over 24 hours >0.4 PO 10-20mmol PO/day

Question 66

coarse tremor (a fine tremor is seen in therapeutic levels) hyperreflexia acute confusion polyuria seizure coma =

Answer 66

Lithium toxicity

Question 67

Mx lithium toxicity (2)

Answer 67

Fluids Haemodialysis

Question 68

Overdose and poisoning management Paracetamol (2) Salicyclate (2) Opiods (1)

Answer 68

Activated charcoal if <1 hour NAC IV bicarb Haemodialysis Naloxone

Question 69

Overdose and poisoning management Benzos (1) TCAs (2) Lithium (2)

Answer 69

Flumezanil IV bicarb Dialysis Fluids Haemodialysis

Question 70

Overdose and poisoning management Heparin (1) BB (1) Methanol (2)

Answer 70

Protamine sulphate Atropine Fomepizaole Haemodialysis

Question 71

Overdose and poisoning management Organophosphate insecticides (1) Iron (1)

Answer 71

Atropine Desferrioxamine

Question 72

Overdose and poisoning management Lead CO (2) Cyanide (1) Ethylene glycol (1)

Answer 72

100% oxygen Hyperbaric oxygen Hydroxocobalamin Fomepizole

Question 73

Salivation Lacrimation Urination Defecation/diarrhoea (SLUD) cardiovascular: hypotension, bradycardia also: small pupils, muscle fasciculation =

Answer 73

Organophosphate insecticide poisoning

Question 74

Mx of opioid dependence (2) How long should detox last? Inpt versus community

Answer 74

Methadone Buprenorphine 4 weeks 12 weeks

Question 75

Name two medications that can cause occulogyric crisis (2) Mx (2)

Answer 75

Antipsychotics Metoclopramide Benztropine Procyclidine

Question 76

Motion sickness mx (3)

Answer 76

Transdermal hyoscine Cyclizine Cinnarizine

Question 77

What creatinine should lead to a review in metformin, when should it be stopped

Answer 77

>130 >150

Question 78

Iodine XRs such as coronary angio can increase risk of renal impairment. If on metformin when should it be discontinued and restarted

Answer 78

On the day of the procedure and 48 hours after

Question 79

SE of mefloquine (3) How long can it last?

Answer 79

Neuropsychiatric side effects - suicide and deliberate self harm - nightmares - anxiety Long half life so can continue for several months

Question 80

Examples of macrolides (3) Adverse effects (2)

Answer 80

Clarithro Azithro Erythro Bacteriostatic Long QT Cholestatic jaundice

Question 81

Azithro SE (2)

Answer 81

Hearing loss Tinnitus