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AAA MSRA > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

Time passed since ingestion for paracetamol levels?

A

4 hours

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2
Q

How long is NAC infused over & why?

A

1 hour to reduce anaphylactoid reaction (non-IgE mediated mast cell release)

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3
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

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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4
Q

Contraindications to viagra

A

patients taking nitrates and related drugs such as nicorandil

hypotension

recent stroke or myocardial infarction (NICE recommend waiting 6 months)

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5
Q

What are the adverse effects of Gentamicin?

A

Ototoxicity & Nephrotoxicity

Contraindication - myasthenia gravis

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6
Q

Drugs causing lung fibrosis

A
  • amiodarone
  • cytotoxic agents: busulphan, bleomycin
  • anti-rheumatoid drugs: methotrexate, sulfasalazine
  • nitrofurantoin
  • ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
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7
Q

Adverse effects of macrolides e.g erythromycin

A

Prolongation of the QT interval

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8
Q

Why should statins be stopped when taking macrolides?

A

Increases the risk of myopathy and rhabdomyolysis

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9
Q

Recommend Adult Life Support (ALS) adrenaline doses

A

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1ml of 1:1000 IV

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10
Q

Inducers of the P450 system

A

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)

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11
Q

Inhibitors of the P450 system include

A

antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin

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12
Q

Adverse effects of Quinolones (ciprofloxacin, levofloxacin)

A

lower seizure threshold in patients with epilepsy

tendon damage (including rupture) - the risk is increased in patients also taking steroids

cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children

lengthens QT interval

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13
Q

Contraindications of Quinolones (ciprofloxacin, levofloxacin)

A

women who are pregnant or breastfeeding

avoid in G6PD

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14
Q

Which medications may exacerbate heart failure

A

thiazolidinediones -
pioglitazone is contraindicated as it causes fluid retention

verapamil -
negative inotropic effect

NSAIDs/glucocorticoids -
should be used with caution as they cause fluid retention,
low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks

class I antiarrhythmics -
flecainide (negative inotropic and proarrhythmic effect)

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15
Q

Side effects of amiodarone

A

Thyroid issues, pulmonary fibrosis, corneal deposits, photosensitivity reactions and derangement in liver function tests.

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16
Q

Most common side effects of Rifampicin

A

Orange bodily fluids, rash, hepatotoxicity, drug interactions

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17
Q

Most common side effects of Isoniazid

A

Peripheral neuropathy, psychosis, hepatotoxicity

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18
Q

Most common side effects of Pyrazinamide

A

Arthralgia, gout, hepatotoxicity, nausea

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19
Q

Most common side effects of Ethambutol

A

Optic neuritis, rash

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20
Q

Most important reason in giving HRT to younger women

A

Preventing the development of osteoporosis

Other benefits include a reduced incidence of colorectal cancer

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21
Q

Why is oestrogen combined with progestogen in a woman with a uterus?

A

to reduce the risk of endometrial cancer

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22
Q

Investigations prior to TB therapy?

A

LFTs
Visual acuity and renal function should also be checked prior to starting ethambutol

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23
Q

What complication may be prevented by the co-prescription of pyridoxine?

A

The risk of peripheral neuropathy with isoniazid can be reduced by prescribing pyridoxine

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24
Q

Signs of lithium toxicity

A

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

Toxicity may be precipitated by:
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole

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25
Side effects of ACE inhibitors
• Cough • Hyperkalaemia
26
Side effects of Bendroflumethiazide
Gout Hypokalaemia Hyponatraemia Impaired glucose tolerance
27
Side effects of Calcium channel blockers
Headache Flushing Ankle oedema
28
Side effects of Beta-blockers
Bronchospasm (especially in asthmatics) Fatigue Cold peripheries
29
Side effects of Doxazosin
Postural hypotension
30
Side effects of Sulfonylureas e.g. Glicazide
Hypoglycaemic episodes Increased appetite and weight gain Syndrome of inappropriate ADH secretion Liver dysfunction (cholestatic)
30
Side effects of Gliptins
Pancreatitis
30
Side effects of Glitazones
Weight gain Fluid retention Liver dysfunction Fractures
31
Drug-induced urinary retention
tricyclic antidepressants e.g. amitriptyline anticholinergics e.g. antipsychotics, antihistamines opioids NSAIDs disopyramide
32
Drugs which can precipitate digoxin toxicity
drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
33
Harmful drugs antibiotics i pregnancy
Antibiotics tetracyclines aminoglycosides sulphonamides and trimethoprim quinolones: the BNF advises to avoid due to arthropathy in some animal studies
34
Harmful drugs in pregnancy
Other drugs ACE inhibitors, angiotensin II receptor antagonists statins warfarin sulfonylureas retinoids (including topical) cytotoxic agents The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful. The decision to stop such treatments however is difficult as uncontrolled epilepsy is also a risk
35
Drugs causing photosensitivity
thiazides tetracyclines, sulphonamides, ciprofloxacin amiodarone NSAIDs e.g. piroxicam psoralens sulphonylureas
36
Amoxicillin S/E
Rash with infectious mononucleosis
37
Co-amoxiclav S/E
Cholestasis
38
Flucloxacillin S/E
Cholestasis (usually develops several weeks after use)
39
Erythromycin S/E
Gastrointestinal upset Prolongs QT interval
40
Ciprofloxacin S/E
Lowers seizure threshold Tendonitis
41
Metronidazole S/E
Reaction following alcohol ingestion
42
Doxycycline S/E
Photosensitivity
43
Trimethoprim S/E
Rashes, including photosensitivity Pruritus Suppression of haematopoiesis
44
45
Drugs to avoid in renal failure
antibiotics: tetracycline, nitrofurantoin NSAIDs lithium metformin
46
Teratogenic effect of Warfarin
Craniofacial abnormalities
47
Teratogenic effect of Valproate
Neural tube defects Craniofacial abnormalities
48
Teratogenic effect of Thalidomide
Limb reduction defects
49
Teratogenic effect of Tetracyclines
Discoloured teeth
50
Teratogenic effect of smoking
Preterm labour Intrauterine growth retardation
51
Teratogenic effect of Maternal diabetes mellitus
Maternal diabetes mellitus Macrosomia Neural tube defects Polyhydramnios Preterm labour Caudal regression syndrome
52
Teratogenic effect of Lithium
Ebstein's anomaly (atrialized right ventricle)
53
Teratogenic effect of Diethylstilbesterol
Vaginal clear cell adenocarcinoma
54
Teratogenic effect of Cocaine
Intrauterine growth retardation Preterm labour
55
Teratogenic effect of Chloramphenicol
'Grey baby' syndrome
56
Teratogenic effect of Carbamazepine
Neural tube defects Craniofacial abnormalities Chloramphenicol
57
Teratogenic effect of Aminoglycosides
Ototoxicity
58
Teratogenic effect of Alcohol
Craniofacial abnormalities
59
Teratogenic effect of Ace I
Renal dysgenesis Craniofacial abnormalities
60
Drug-induced thrombocytopenia
Drug-induced thrombocytopenia (probable immune-mediated) quinine abciximab NSAIDs diuretics: furosemide antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate heparin
61
Visual changes secondary to drugs
blue vision: Viagra ('the blue pill') yellow-green vision: digoxin
62
Drugs causing ocular problems
Cataracts steroids Corneal opacities amiodarone indomethacin Optic neuritis ethambutol amiodarone metronidazole Retinopathy chloroquine, quinine Sildenafil can cause both blue discolouration and non-arteritic anterior ischaemic neuropathy
63
Ecstasy poisoning features & management
Clinical features neurological: agitation, anxiety, confusion, ataxia cardiovascular: tachycardia, hypertension hyponatraemia this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA hyperthermia rhabdomyolysis Management supportive dantrolene may be used for hyperthermia if simple measures fail
63
Organophosphate insecticide poisoning features & management
Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD) Salivation Lacrimation Urination Defecation/diarrhoea cardiovascular: hypotension, bradycardia also: small pupils, muscle fasciculation Management atropine the role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit
64
Tamoxifen adverse effects
menstrual disturbance: vaginal bleeding, amenorrhoea hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects venous thromboembolism endometrial cancer
65
Why is aspirin contraindicated in <16
Risk of Reye's syndrome
66

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