Pharmacology

Question 1

Orlistat (Indications?)

Answer 1

• Age 18-75
• BMI of 28 or more w/ risk factors
• BMI of 30 or more
• -

Question 2

Orlistat (How does it work)

Answer 2

Lipase inhibitor (reduces absoprtion of dietary fat)

Question 3

Orlistat (Contraindications)

Answer 3

Chronic Malabsorption syndrome
Cholestasis
Breastfeeding

Question 4

Which SSRI can affect/cause HTN?

Answer 4

Venlafaxine

Question 5

What is Malarone and what are the side effects?

Answer 5

Anti-malarial containing a combination of atovaquone and proguanil.

**Side effects: GI upset, headaches, skin rash, mouth ulcers **

Question 6

What is Mefloquine and what are the side effects?

Answer 6

Antimalarial drug.

**Side effects: Dizziness, Sleep disturbances (Insomnia, vivid dreams) and neuropsychiatric disturbance (anxiety, depression, panic attacks, hallucinations)
**
Contraindicated in epilepsy

Question 7

What is chloroquine and what are the side effects?

Answer 7

Antimalarial
Rarely used now

Side effects: Headache
Contraindicated in epilepsy

SAFER OPTION TO USE IN PREGNANCY - but high levels of resistance

Question 8

Antimalarials in pregnancy

Answer 8

If travel cannot be avoided:
- Chloroquine can be taken
- Proguanil: folate supplementation (5mg od) should be given

Malarone (atovaquone + proguanil): the BNF advises to avoid these drugs unless essential. If taken then folate supplementation should be given
mefloquine: caution advised
doxycycline is contraindicated

Question 9

Lithium side effects

Answer 9

Nausea/vomiting, diarrhoea
Fine tremor
Weight gain

Nephrotoxicity - polyuria
Thyroid enlargement (can cause hypothyroid)
Hyperparathyroidism + hypercalcaemia
IIH

ECG: T wave flattening/inversion
Leucocytosis

Question 10

Lithium monitoring
- When should lithium levels be checked
- How often monitorng when starting/dose change
- How often once stable and what other blood tests?

Answer 10

Lithium levels should be checked 12 hours post-dose

Lihtium levels should be done weekly after starting and after each dose change until concentrations stable

Lithium levels should normally be checked every 3 months
TFT and renal funciton should be checked every 6 months

Question 11

Precipitants for lithium toxicity?

Answer 11

Dehydration
Renal failure
Drugs - Metronidazole, ACE-I, NSAIDs, Thiazide diuretics (MANT)

Question 12

Features of lithium toxicity?

Answer 12

Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma

Question 13

Management of lithium toxicity?

Answer 13

Mild-moderate - IV fluids
Severe - Haemodyalisis
Sodium bicarbonate is sometimes used.

Question 14

Methotrexate side effects?

Answer 14

Mucositis
Myelosuppression
Pneumonitis (typically 1 year after trt)
Pulmonary fibrosis
Liver fibrosis
May affect fertility

Question 15

Methotrexate contraindications

Answer 15

Pregnancy (Teratogenic)
- Women should avoid pregnancy for at least 6 months after treatment stopped
- Men should use contraception for 6 months after treatment

Breastfeeding
Active Infeciton
**Immunodeficinecy **

Question 16

Methotrexate monitoring?

Answer 16

FBC, U&Es, LFTs at start and every 2 weeks until dose stable for 6 weeks (also at dose increases)

Then check monthly for 3 months and then 3 monthly

Question 17

Sulphasalazine - Indications?

Answer 17

IBD, RA

Question 18

Sulphasalazine - Side effects

Answer 18

Rashes
Oligospermia
Headache
Heinz body anaemia
Megaloblastic anaemia
Lung fibrosis

Question 19

Sulphasalazine - Pregnancy/breastfeeding?

Answer 19

Thoeretical risk of neonatal haemolysis in third trimester
Adequate folate supplements should be given

Also theoretical risk of neonatal haemolysis through breastfeeding

Question 20

Pioglitazone - Contraindications

Answer 20

Heart Failure
Bladder Cancer/uninvestigated haematuria
Hepatic impairment

Question 21

Pioglitazone - what is it?

Answer 21

**Thiazolidinedione **
They are agonists to the PPAR-gamma receptor and reduce peripheral insulin resistance.

Question 22

Pioglitazone - Side effects

Answer 22

Weight gain

Liver impairment: monitor LFTs

Fluid retention - therefore contraindicated in heart failure. The risk of fluid retention is increased if the patient also takes insulin

Increased risk of fractures

Increased risk of bladder cancer

Question 23

Dapagliflozin - what type of medication + how does it work?

Answer 23

SLGT-2 inhibitor
Reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.

Question 24

Dapagliflozin/SGLT-2 - side effects

Answer 24

Urinary and genital infection (secondary to glycosuria).

Fournier’s gangrene has also been reported

Normoglycaemic ketoacidosis

Increased risk of lower-limb amputation: feet should be closely monitored

Question 25

Dapagliflozin - contraindications?

Answer 25

DKA Active foot disease (Skin ulceration/osteomyelitis) Renal/hepatic impairment

Question 26

Exenatide? - Type

Answer 26

GLP-1 agonist

Question 27

Exenatide - Contraindications

Answer 27

Ketoacidosis Pancreatitis Renal/Hepatic impairment Severe GI disease (IBD/gastroparesis)

Question 28

Exenatide - Side effects

Answer 28

Weight loss Nausea/vomiting Pancreatitis Renal impairment Cardiac - AV block, sinus tachycardia SKin rash

Question 29

Methylphenidate - weight monitoring?

Answer 29

Every **3 months in children 10 or less** **3 months then 6 months** after treatment started, and **every 6 months** thereafter in everyone aged over 10

Question 30

Methylphenidate - height monitoring frequency?

Answer 30

Every 6 months in children and young people

Question 31

Methylphenidate - BP/HR monitoring

Answer 31

Before and after each dose change Routinely every 6 months

Question 32

Methylphenidate - what aspects need to be monitored?

Answer 32

Weight, height, BP/Pulse

Question 33

Digoxin - MOA?

Answer 33

Decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter Increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump.

Question 34

Digoxin toxicity - precipitating factors?

Answer 34

LOW - Pot, Mg, albumin, temp, thyroid High - Calcium, sodium Drugs - Amiodarone, Qunidine, Verapamil, Diltiazem, Spironolactone (Drugs that cause hypokalaemia - thiazides + loop)

Question 35

Digoxin toxicity - features?

Answer 35

Generally unwell - Lethargy, nausea & vomiting, anorexia, confusion, Yellow-green vision Arrhythmias (e.g. AV block, bradycardia) Gynaecomastia

Question 36

Leflunomide - Contraindications/cautions

Answer 36

**Pregnancy** - the BNF advises: 'Effective contraception essential during treatment and for at least 2 years after treatment in women and at least 3 months after treatment in men (plasma concentration monitoring required' Caution should also be exercised with **pre-existing lung** and **liver disease**

Question 37

Triptans - side effects

Answer 37

Dyspnoea Flushing Fatigue Sensations of tingling/hot/cold

Question 38

Triptans - contraindications

Answer 38

IHD HTN MI CVA - TIA/Stroke

Question 39

Gynaecomastia - Drug causes?

Answer 39

Got DISCO Fever - GnRH ag - goserelin - Digoxin - Isoniazid - Spiro - Cimetidine - Omeprazole/ oestrogens - Finasteride

Question 40

Tinnitus - Drug Causes?

Answer 40

Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine