Pharmacology

Question 1

What are the 2 major manifestations of Digoxin toxicity? How should it be managed when life-threatening?

Answer 1

1) GI disturbance (Nausea, vomiting and diarrhoea)
2) Hyperkalaemia –> Arrhythmias (e.g. atrial tachycardia with 2:1 conduction block)

Treat with Digoxin-specific antibody (FAb). Do NOT give Calcium gluconate for the hyperkalaemia, as may worsen toxicity

Question 2

Give 3 contraindications to Digoxin

Answer 2

1) 2nd and 3rd degree heart block
2) Hypokalaemia
3) Hypercalcaemia

Question 3

Give 3 contraindications to Verapamil/Diltiazem

Answer 3

1) Heart failure
2) 2nd/3rd degree heart block
3) Concurrent B-blocker use

Question 4

Give 2 contraindications so Amlodipine/Nifedipine

Answer 4

1) Unstable angina

2) Severe aortic stenosis

Question 5

Give 2 contraindications to ACEi

Answer 5

1) Renal artery stenosis

2) Pregnancy

Question 6

Give 3 common side-effects of ACEi

Answer 6

1) hypotension
2) hyperkalaemia
3) dry cough

Question 7

Give 3 side-effects of loop diuretics

Answer 7

1) hypotension
2) electrolyte disturbance (e.g. hypokalaemia, hyponatraemia)
3) sensorineural hearing loss and tinnitus

Question 8

Give 2 side-effects of thiazide diuretics

Answer 8

1) electrolyte disturbance (hypokalaemia, hyponatraemia)

2) impotence (in men)

Question 9

Name 3 side-effects of aldosterone antagonists (potassium-sparing diuretics)

Answer 9

1) Stevens-Johnson syndrome
2) hyperkalaemia
3) Gynaecomastia

Question 10

Give 3 contraindications for B-blockers

Answer 10

1) asthma
2) 2nd/3rd degree heart block
3) Concurrent use of verapamil/diltiazem

Question 11

How should B-blockers be started in heart failure and why?

Answer 11

Start at low dose and increase slowly

They may impair cardiac function

Question 12

Which B-blockers can be used in heart failure?

Answer 12

1) Bisoprolol

2) Carvedilol

Question 13

What blood test is used to monitor unfractionated heparin?

Answer 13

APTT

Question 14

What blood test is used to monitor Warfarin and how is the INR calculated from this?

Answer 14

PT

INR = PT of patient / pt of control

Question 15

Name 4 common CP450 enzyme inducers that may interfere with Warfarin metabolism

Answer 15

1) Carbamazepine
2) Rifampicin
3) Alcohol
4) Phenytoin

Question 16

Name 4 common CP450 enzyme inhibitors that may interfere with warfarin metabolism

Answer 16

1) Macrolide antibiotics (e.g. erythromycin)
2) Grapefruit juice
3) Amiodarone
4) Diltiazem

Question 17

Name 3 side-effects of statins

Answer 17

1) Myopathy (muscle aches)
2) Rhabdomyolysis
3) Hepatitis

Question 18

Can statins be given in pregnancy?

Answer 18

No

Question 19

How should a patient be monitored when initiating a statin?

Answer 19

Lipid profile and LFTs at baseline, 3 and 6 months