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Pharmacology Flashcards

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1
Q

What are these drugs?
Omeprazole.
Lansoprazole.
Pantoprazole.
Rabeprazole.
Esomeprazole.

Common SE?

A

PPIs
Proton pump inhibitors (PPI) cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.

Examples include omeprazole and lansoprazole.

Adverse effects
hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

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2
Q

What is Hydroxocobalamin?

A

Hydroxocobalamin is a manufactured version of the vitamin B12. It’s used to treat and prevent vitamin B12 deficiency anaemia,

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3
Q

What class is ceftriaxone? (beginning with CEF)

A

Cephalosporin antibiotics

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4
Q

What class are metoclopramide, domperidone, chlorpromazine?

A

Antiemetics (anti-sickness)

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5
Q

What is octreotide?

A

Synthetic version of somatostatin (a somatostatin analogue) and slows down the production of hormones. This helps to control the symptoms of carcinoid syndrome and slow down the growth of the cancer.

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6
Q

What is gabapentin?

A

Group of gabapentimoids
Used to treat neuropathic pain- sciatica
Can be addictive and drowsy

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7
Q

What SSRI can be used for children?

A

Fluoxetine

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8
Q

Signs and symptoms of wernickes?
CAN OPEN

A

C- confusion
A- ataxia
N- nystagmus

O- ophthalmoplegia
PE- peripheral
N- neuropathy

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9
Q

P450 enzyme inducers?

A

Inducers of the P450 system include:

phenytoin
carbamazepine
rifampicin
St John’s Wort
topiramate
chronic alcohol intake
smoking

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10
Q

P450 enzyme inhibitors?

A

antibiotics: ciprofloxacin, erythromycin
Isoniazid
amiodarone
allopurinol
SSRIs: fluoxetine, sertraline
sodium valproate
acute alcohol intake
omeprazole

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11
Q

Important side-effects to monitor when taking gentamicin?

A

Ototoxicity + nephrotoxicity

Gentamicin- aminoglycoside antibiotic

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12
Q

How to monitor for digoxin toxicity?

A

If toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose

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13
Q

MOA of digoxin?

A

Decreases conduction through the AVN node and slow ventricular rate in AF/ flutter

Increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump

Can cause hypokalaemia

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14
Q

Indication for liver transplant following paracetamol overdose?

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

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15
Q

Management for TCA overdose?

signs & symptoms?

A

ABCDE
Cardiac monitoring
Activated charcoal within 1hr of overdose
IV fluids
Sodium bicarb if acidotic
Benzo for seizures

S&S:
Everything dry (mouth, eyes, oliguria, palpitations, drowsiness, confusion)

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16
Q

Features of lithium toxicity?

A

coarse tremor
hyperreflexia
acute confusion
polyuria
seizure
coma

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17
Q

Common SE of CCBs?
Nifedipine, amlodipine, felodipine
(dihydropyridines)

A

Ankle swelling

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18
Q

MOA of aspirin?

A

Aspirin is a non-reversible COX 1 and 2 inhibitor

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19
Q

MOA of clopidogrel and ticagrelor?

A

P2Y12-ADP receptor antagonists act to prevent platelet activation and aggregation.

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20
Q

Management for hypomagnesemia?

A

IV magnesium is usually given if <0.4 mmol/L or tetany, arrhythmias, or seizures

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21
Q

Management for paracetamol overdose >25hrs?

A

If presentation > 24 hours after an overdose start N-acetylcysteine if the patient is jaundiced, has hepatic tenderness or an elevated ALT

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22
Q

Azathioprine monitoring bloods?

A

FBC
LFT

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23
Q

Simvastatin (first 12 months of treatment) monitoring bloods?

A

LFT

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24
Q

ACEi monitoring bloods?

A

U&Es

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25
Amiodarone monitoring bloods?
TFT LFT
26
Methotrexate monitoring bloods?
FBC LFT U&Es
27
Lithium monitoring bloods?
Drug level TFT U&Es
28
What drugs are renally excreted?
Digoxin Beta-blockers Lithium Cephalosporin Aminoglycosides- streptomycin, gentamycin Loop diuretics- furosemide Thiazide diuretics- hydrochlorothiazide Potassium-sparing diuretics- spironolactone Allopurinol ACEi
29
List of drugs metabolised by the liver?
Propranolol GTN Morphine Diazepam Simvastatin Verapamil Methadone
30
Black triangle meaning in the BNF?
New drug that is under surveillance for adverse reactions
31
Rectangle symbol on the BNF 50:50 black and white?
Denotes a preparation that is less suitable to prescribe
32
What are the features of digoxin toxicity?
-generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision -arrhythmias (AV block, bradycardia) -gynaecomastia
33
Contraception methods that are not affected by enzyme metabolism?
Progesterone injectables IUS IUD
34
Contraception methods that are by enzyme metabolism?
COCP POP Implant
35
Enzyme inducers vs enzyme inhibitors?
Inhibitors (effects can be seen quickly) Increase the concentration of drugs metabolised by the cytochrome P450 system so dose may need to be reduced. Inducers Normally requires long exposure to see effects so dose may need to be increased Reduce the concentration of drugs metabolised by the cytochrome P450 system.
36
OCP and enzyme inducers, what is the problem?
OCP are metabolised by the hepatic P450 enzyme Enzyme inducers (carbamazepine, phenytoin, rifampicin) increased the metabolism of the drug and reduce its concentration, thus increasing risk of getting pregnant.
37
What drugs require therapeutic drug monitoring? What is it?
Gentamicin Carbamazepine Digoxin Lithium Therapeutic drug monitoring is the measurement of specific drug concentrations in the blood at timed intervals, in order to maintain a relatively constant concentration of the medication in the circulation. Monitored drugs tend to have a narrow "therapeutic index" – the difference between the toxic and therapeutic doses of medications.
38
Investigations in anaphylaxis?
ECG ABG Bloods- mast cell tryptase
39
Anaphylaxisis management?
ABCDE IM adrenaline (0.5ml/ 500mcg) x 2 doses Oxygen Bronchodilators- salbutamol/ ipratropium for wheeze IV fluids for hypotension
40
Once-stabilised anaphylaxis management?
Non-sedating oral antihistamine (e.g. 10-20mg cetirizine) - if not able to swallow can give IV or IM chlorphenamine Steroids only if patient has asthma Observe patients for a biphasic reaction (when symptoms of anaphylaxis reoccur without further exposure to a trigger) -low risk 2 hours -medium risk 6 hours -high risk 12 hours
41
What abx drugs are CI to take with statins?
Macrolides (clarithromycin/ erythromycin) cause rhabdomyolysis
42
Side effects of steroids? Systemic SE GI SE Psychiatric Topical steroids SE Inhaled SE Ocular SE
Systemic: hyperglycaemia osteoporosis/ ANV of femoral head adrenal suppression Cushing's syndrome weight gain hirsutism Gastrointestinal: peptic ulceration, acute pancreatitis Psychiatric: insomnia, mania, depression, psychosis Topical corticosteroids: skin thinning and bruising, Inhaled corticosteroids: candidiasis or dysphonia. Ocular: glaucoma and cataracts. Long-term paediatric use can result in growth retardation.
43
Overdose management for: Paracetamol Opiates Benzodiazepines Tricyclic antidepressants Lithium Warfarin Iron Lead Methanol Carbon monoxide Salicylate
Paracetamol: <1hr charcoal, NAC >24hrs and staggered doses, liver transplant Opiates: Naloxone (400mcg bolus if severe respiratory arrest, titrated if moderate) Digoxin: Digibind Benzodiazepines: Flumazenil of if severe OD Tricyclic antidepressants: IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity Lithium: mild-moderate toxicity may respond to volume resuscitation with normal saline haemodialysis may be needed in severe toxicity Warfarin: Vitamin K and prothrombin complex Iron: Desferrioxamine, a chelating agent Lead: Dimercaprol, calcium edetate Methanol: fomepizole or ethanol haemodialysis Carbon monoxide: 100% oxygen hyperbaric oxygen Salicylate: urinary alkalinization with IV bicarbonate, haemodialysis
44
SE of digoxin metabolic?
Hypokalaemia digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
45
Yellow card on BNF meaning?
Severe drug reaction
46
What drug can cause hypersensitivity reactions, including phototoxic and photoallergic reactions?
Amiodarone
47
If you have a penicillin allergy what else are you likely to be allergic to?
Cephalosporins (cefotaxime, cephalexin, ceftriaxone)
48
How should statins be monitored?
LFTs-> transaminases (ALT, AST)
49
SE of ciclosporin immunosuppressant?
Hepatoxicity/ nephrotoxicity
50
Monitoring for LMWH?
No routine monitoring needed, but in special situations check anti-Factor Xa levels.
51
Management for cocaine toxicity?
Benzodiazepines If chest pain-> benzodiazepines + glyceryl trinitrate
52
Monitoring for amiodarone?
TFT + LFT
53
AKI causing drugs? DAMN
Diuretics ACE inhibitors/ARBs Metformin NSAIDs Aminoglycosides-gentamicin, amikacin, tobramycin, streptomycin and neomycin Digoxin
54
Drugs that can cause hypomagnesaemia?
PPIs Diuretics
55
Patients taking amiodarone are at an increased risk of thyroid dysfunction. What problems may long-term amiodarone use cause?
Hypothyroidism + thyrotoxicosis
56
Which medications can cause gingival hyperplasia?
CCBs (amlodipine, nifedipine)
57
What is the mechanism of action of sildenafil?
Phosphodiesterase type V inhibitor
58
SE of doxycycline?
Sensitivity to light
59
Anaphylaxis and cardiac arrest adrenaline doses?
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
60
What age should women with premature menopause continue HRT until?
Until 50 years old
61
SE of CCBs?
Calcium channel blockers - side-effects: headache, flushing, ankle oedema
62
How should the therapeutic efficacy be monitored of unfractionated heparin?
Measure APTT
63
Which medication can cause yellow-green tinting of vision?
Digoxin
64
SE of ciclosporin?
Ciclosporin side-effects: everything is increased - fluid, BP, K+, hair, gums, glucose
65
What reaction can NAC cause?
N-Acetylcysteine commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release)
66
Cardiac SE of macrolides (Clarythromycin/ erythromycin)?
prolongation of the QT interval
67
Management for hypomagnesaemia? Mild Severe SE of treatment
>0.4 mmol/l oral magnesium salts (10-20 mmol orally per day in divided doses) diarrhoea can occur with oral magnesium salts <0.4 mmol/L or tetany, arrhythmias, or seizures IV magnesium replacement
68
Management for adrenaline-induced ischaemia?
Phentolamine- alpha blocker
69
Management for oculogyric crisis?
Procyclidine
70
What are these drugs used for? Oxytocin Ergometrine Mifepristone
Oxytocin- induce labour Ergometrine- alternative to oxytocin in the active management of third stage of labour Mifepristone/misoprostol- terminate pregnancies
71
Drugs that cause lung fibrosis?
bleomycin nitrofurantoin methotrexate cyclophosphamide amiodarone.
72
Cardiac SE of Clarythromycin?
Prolonged PR interval
73
Why does drinking too much alcohol cause polyuria?
Ethanol inhibits ADH secretion
74
Which medication can cause sleep disturbance?
Beta-blockers
75
List drug-induced urinary retention medications?
TCA- amitriptyline NSAIDs Opioids Antipsychotics Antihistamines
76
Drugs that can cause gynaecomastia?
Spironolactone Finasteride Ketoconazole Metronidazole
77
When to check lithium levels after last dose?
12 hours after
78
When to check digoxin levels after last dose?
6 hours after
79
When to check ciclosporin levels after last dose?
Immediately
80
Which abx can cause prolonged QT interval?
Clarithromycin
81

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