Pharmacology

Question 1

Digoxin toxicity Fx

Answer 1

yellow/ green vision
nausea
confusion
arrythmia - av block, brady
gynaecomastia

take levels 6 hours after last dose

Question 2

Digoxin toxicity precipitating factors

Answer 2

hypoKal
renal failure
heart failure
Amiodarone
verapamil
diltizaem
spirinolactone

Question 3

Causes of hypoMAG

Answer 3

Diuretics
PPIs
TPN
diarrhoea
HypoK
HyperCal

Question 4

Inducers of P450 (therefore reduce INR)

Answer 4

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

Question 5

Inhibitor of P450 (increases INR)

Answer 5

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

Question 6

Lithium toxicity precipitating factors

Answer 6

dehydration
renal failure
drugs - thiazides, ACEi/ ARB, NSAIDs, metronidazole

Question 7

Reasons for HRT for Premature Ovarian Insufficiency

Answer 7

CVD
Osteoporosis
cognitive impairment

Question 8

Serotonin syndrome Fx

Answer 8

sweating
tremor
confusion
tachycardia
hypertension
dilated pupils
hypERreflexia + Clonus

Question 9

Neuroleptic malignant syndrome Fx

Answer 9

Symptoms gradual over days
bradykinesia
hyporeflexia
hypotension
rigidity

Question 10

Macrolides (eg Clarithromycin, azithromycin) SE

Answer 10

Prolonged QT
GI upset
Cholestatic jaundice
P450 inhib
Azithro - hearing loss + tinnitus

Question 11

Oculogyric crisis Fx

Answer 11

Agitated
clenched jaw
eyes deviated upwards

Question 12

Oculogyric crisis causes

Answer 12

antipsychotics
metoclopramide
Parkinsons disease

Question 13

Urticaria causes (medications)

Answer 13

aspirin
penicillin
NSAIDs
opiates

Question 14

Amiodarone monitoring

Answer 14

CXR one off initially
TFT, LFT every 6 months

Question 15

Lithium toxicity Fx

Answer 15

Coarse tremor (fine tremor in therapeutic levels)
hyperreflexia
confusion
seizures

Question 16

Isoniazid SE

Answer 16

Peripheral neuropathy - prevent with Pyridoxine (Vit B6)
hepatitis, agranulocytosis
P450 inhib

Question 17

Mefloquine contraindication

Answer 17

Mental health disorders - can exacerbate MH symptoms

Question 18

Statin monitoring

Answer 18

LFT at baseline, 3 and 12 months

Question 19

Lithium monitoring

Answer 19

TFT, UE prior to treatment, and every 6 months
Lithium levels weekly until stable, then every 3 months

Question 20

Rifampicin SE

Answer 20

hepatitis
orange secretions
P450 inducer

Question 21

Ciclosporin SE

Answer 21

Everything is increased - fluid, bp, K, hair, gums, glucose

Question 22

What renal function do you consider to change metformin

Answer 22

creatinine > 130
eGFR <45
if eGFR <30 - Metformin is contraindicated and must be switched

Metformin should no be started after episode of hypoxia eg MI, AKI, sepsis

Question 23

Reactivation of Tb SE

Answer 23

Etanercept
Infliximab
Adalimumab

Question 24

Gold SE

Answer 24

Proteinuria

Question 25

Oligospermia SE of what medication

Answer 25

Sulfasalazine

Question 26

Hydroxychloroquine SE

Answer 26

Retinopathy Corneal deposits

Question 27

What groups should have daily Vit D supplements

Answer 27

pregnant and breastfeeding women Children 6months - 5 years. Unless taking fortified milk Adults >65yo Not exposed to the sun eg housebound patients

Question 28

ACEi monitoring

Answer 28

UE baseline, every change in dose, yearly

Question 29

Methotrexate monitoring

Answer 29

FBC, UE, LFT baseline, weekly until stable, then 3 monthly

Question 30

Azathioprine monitoring

Answer 30

FBC, LFT baseline FBC weekly first 4 weeks FBC, LFT every 3 months

Question 31

Drug induced impaired glucose tolerance (6)

Answer 31

thiazides, furosemide (less common) steroids tacrolimus, ciclosporin interferon-alpha nicotinic acid antipsychotics

Question 32

Medications contraindicated in pregnancy

Answer 32

Antibiotics tetracyclines - Doxycycline aminoglycosides - Gentamicin sulphonamides and trimethoprim quinolones - ciprofloxacin Other drugs ACE inhibitors, angiotensin II receptor antagonists statins warfarin sulfonylureas retinoids (including topical) cytotoxic agents

Question 33

Flucloxacillin SE

Answer 33

Cholestatis Hepatitis

Question 34

Ciprofloxacin SE

Answer 34

reduce seizure threshold

Question 35

Sodium valproate monitoring

Answer 35

LFT, FBC baseline LFT every 6 months

Question 36

ALS adrenaline doses anaphylaxis cardiac arrest

Answer 36

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

Question 37

Contraindication to Disulfiram (for alcohol detox)

Answer 37

Cardiac failure Cerebrovascular disease Psychosis/ suicide risk

Question 38

Contraindication to Acamprostate (for alcohol detox)

Answer 38

liver impairment renal impairment

Question 39

Contraindication to Bupropion (for smoking cessation)

Answer 39

Seizures eating disorders pregnancy bipolar

Question 40

Contraindication to Varenicline (for smoking cessation)

Answer 40

Depression Suicidal thoughts

Question 41

Alcohol detox medication

Answer 41

Disulfiram - increases alcohol sensitivity - makes person sick if drinks alcohol Acamprosate - reduces cravings