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Phase 4 > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

If a person has an INR of >5 but has no bleeding, what management should be implemented?

A

With hold 1-2 does and reduced maintenance

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2
Q

If a person has an INR of >5-8 and is bleeding what management should be implemented?

A

Stop warfarin

1-3mg of Vit K

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3
Q

if a person is bleeding and has an INR of >8 and is on warfarin?

A

Stop warfarin

5mg Vit K IV

FFP

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4
Q

Does metformin increase endogenous insulin?

A

no

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5
Q

If a patient is on a calcium channel blocker and is developing ankle oedema, what medication can they be switched too if the are hemodynamically stable?

A

to avoid polypharmacy, swapping the Ca2+ to a thiazide such as:
- indapamide

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6
Q

What does Isoniziade do to the P450 system?

A

inhibits it

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7
Q

What are the side effects of cocaine?

A

M.I
Tachy/ Brady cardia
Widening QRS
aortic dissection

Seizures
Mydriasis
Hypertonia
Hyper-reflexia

Agitation
psychosis

Hyperthermia

Ulcerative colitis

Metabolic acidosis
Rhabdomyolysis

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8
Q

What type of drug can be used for psychotic delusions?

A

Dopamine antagonists

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9
Q

Most important toxicity implication to watch out for in gentamicin?

A

nephrotoxicity

ototoxicity

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10
Q

Macrolides should not be prescribed along side some blood pressure medications, what are these?

A

Amlodipine
Diltiazem
Verapamil

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11
Q

Tetracyclines should not be given with certain drugs, why is this?

A

Tetracyclines are chelating agents, so will bind and prevent absorption of multiple agents.
this is very important when a patient is on:
- Ferrous fumarate or other irons
as they will bind together and neither will be absorbed.

it is also why tetracyclines should be avoided with milk or other Ca2+ containing foods.

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12
Q

What anti-malarial is associated with psychosis?

A

Mefloquine

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13
Q

Following Tricyclic Antidepressants a patient develops widening QRS, what should be administered?

A

Sodium bicarbonate

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14
Q

Which drug can interact with levothyroxine absorption?

A

Iron and calcium

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15
Q

Name some side effects of cyclosporine:

A 
Hypertension 
nephrotoxicity 
hepatotoxicity 
Gingival hyperplasia 
Hyperlipidaemia
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16
Q

Which TB drug is most associated with peripheral neuropathy?

A

Isoniazid

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17
Q

What drug is Sildenafil contraindicated with?

A

Nicorandil

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18
Q

Mechanism of action of ondansetron?

A

5HT3

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19
Q

Which antibiotics other than vancomycin also has activity MRSA?

A

Teicoplanin

linezolid

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20
Q

In soft skin infection if a person has a true penicillin allergy, what antibiotic can be used?

A

Doxycycline

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21
Q

What are the drugs that can be used in an MRSA patient?

A

Doxycycline

Clindamycin

Co-trimoxazole

Vancomycin

Teicoplanin

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22
Q

What do extended spectrum beta lactamases tend to be sensitive too?

A

Meropenem

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23
Q

What are the two metabolites of opioids?

A

• Morphine-3- glucuronide/ M3G
- This may be inactive or antagonise the effect of morphine

• Morphine -6-glucuronide/ M6G  This may actually be more active than morphine
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24
Q

Which opioid is preferred when there is CKD? what dose should it be administered at in comparison to morphine and what is the recommended eGFR?

A

Oxycodone

  • eGFR >30
  • 50% of morphine
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25
Which Opioid can be given as a transdermal patch? What can lead to an increase in its absorption? and what is it not good for?
Fentanyl Fever can increase is absorption Slow release through patch so not good for immediate acute pain
26
What schedule on the controlled drugs is tramadol?
Schedule 3
27
What stage of the WHO pain ladder is tramadol used?
Step 2
28
What kind of pain is tramadol useful for?
Neuropathic pain - used 2nd line for break through pain inflammatory pain
29
Alfentanil is a controlled drug, what schedule is it?
Schedule 2
30
How potent is Alfentanil?
1/4 the potency of fentanyl
31
Alfentanil can be used in a particular circumstance that a lot of other drugs can't be, when is this?
when the eGFR is <30
32
In a patient with delirium who also has parkinson's disease, what is the best pharmacological management for them?
Lorazepam Haloperidol and other antipsychotics should be avoided in parkinson's disease.
33
Who should not receive aspirin?
Asthmatics - bronchospasm Third trimester pregnancy - Ductus arterioles Peptic ulceration Gout patient
34
How does clopidogrel and ticagrelor work?
ADP receptor antagonist | - inhibiting GPIIb/IIIa from forming
35
Why should clopidogrel not be taking with omeprazole?
Clopidogrel is a pro-drug activated by P450 enzymes. Omeprazole is an inhibitor - thus should not be used in combination as the therapeutic effects of clopidogrel will be lost. Lansoprazole is preferred.
36
When should iron supplementation be stopped before a colonoscopy and why?
7 days It can turn the stools black - making it difficult to assess the colon
37
When should clopidogrel be stopped before surgery?
7 days
38
When should allopurinol be started following a gout attack? and what drugs does it interact with?
2 weeks after the attack azathioprine - metabolised by xanthine oxidase Aminotheophyline
39
Following paracetamol overdose, which patients are most likely to develop liver failure?
Alcoholics Anorexia nervosa P450 inducers HIV
40
What drug is given for atypical pneumonia?
Clarithromycin
41
What are the main side effects of glitazones (pioglitazone)
Weight gain fluid retention (swelling) liver dysfunction increased fractures
42
What is the dose of adrenaline given during a cardiac arrest?
10ml 1:10,000 1mg/10ml Given IV
43
What is the dose of adrenaline given during an anaphylaxis shock?
0. 5ml 1:1000 0. 5mg Given IM
44
If a person is on metformin and is acutely ill, what should you advise?
Suspend the metformin during this time | - risk of lactic acidosis
45
What is a major side effect of amitriptyline?
urinary retention
46
How is LMWH monitored and how is heparin monitored?
LMWH: - Anti- Factor Xa Heparin: - APTT
47
Side effects of heparin:
Bleeding Heparin induced thrombocytopenia Osteoporosis Hyperkalemia
48
Which of the DOACs may cause dyspepsia?
Dabigatran *it is also the one not metabolised by CYP 405 enzymes
49
What are some symptoms of digoxin toxicity?
Bradycardia Gastrointestinal upset Blurring of vision - yellow vision Rash * *Arrhythmias - digoxin is a pro-arrhythmic drug
50
Which common blood pressure medication can cause hearing loss/ tinnitus?
Loop diuretics
51
What should be corrected before starting statins?
Hypothyroidism
52
Which drug is given as an antidote for benzodiazepine overdose?
Flumazenil And Activated Charcoal
53
What should be considered when starting people on long term steroids?
STOP S - Sick day rules T - Treatment card O - osteoporosis - bisphosphonates P - PPIs
54
What is the management for digoxin overdose?
Digibind Correct arrhythmias Monitor K+
55
What are some side effects of levodopa?
``` Dyskinesia Hypotension Hallucinations Nausea On- Off effect ```
56
Which anti-epileptic medication is PY45 inducers?
Carbamazepine | Phenytoin
57
What are the indicated uses for carbamazepine?
Epilepsy Trigeminal neuralgia Mood stabilizer
58
What are the indications of use for sodium valproate?
Epilepsy | Bipolar disorder
59
What are some important side effects of carbamazepine?
``` Ataxia dry mouth Diplopia Fatigue SJS** ``` **grapefruit can increase levels
60
What are some important side effects of phenytoin?
Insomnia Rash headache Gingival hyperplasia
61
Name the 1st gen and 2nd gen antipsychotics, how do they work and what are some side effects of them?
1st line: Haloperidol and Chlorpromazine 2nd line: Olanzapine and Clozapine Dopamine Antagonists (D2 receptors)- mesolimbic and nigrostriatal Side effects: - extrapyramidal movement abnormalities - acute dystonic reactions - Sedation - postural hypotension - Hypoprolactinaemia - QT prolongation **contraindicated in Parkinson's disease
62
When is atorvastatin used and at what dosages?
QRISK >10%: 20mg Secondary prevention: 80mg
63
When should NSAIDs be avoided?
Renal failure 3rd trimester - ductus-arteriosus shuts Peptic ulcer disease
64
Which drug causes red man syndrome and how is it managed?
Vancomycin - caused by to rapid injection of the drug Managed by: - withhold until symptoms resolve - restart at slower infusion
65
What are some important drug interactions:
Metformin and cimetidine - inhibits renal clearance Gentamicin and loop diuretics - prevents clearance ACE inhibitors and K+ sparing - Hyperkalemia Statins and macrolides Thiazides and PPI - hyponatremia Thiazide and lithium - toxicity
66
Warfarin and cranberry juice:
Can inhibit breakdown of warfarin | - increasing INR
67
What should you not take with tetracyclines or fluoroquinolones?
Milk
68
How does aciclovir work?
Blocks RNA polymerase
69
Name two bisphosphonates and name some serious complications with them:
Alendronic acid Pamidronate Osteonecrosis of the Jaw Atypical fractures Dyspepsia / Stomach ulcers *take 30 mins before food standing for 30 mins
70
Side effects of carbidopa:
Dyskinesia On Off effect Hallucinations Nausea
71
Why are addison patients placed on hydrocortisone?
It has both glucocorticoid and mineralocorticoid activity
72
What are the side effects of corticosteroids?
``` Sleep disturbance Mood disturbance Weight gain Stria Hyperglycaemia Easy bruising Hypertension Supraclavicular fat Immunodeficiency ```
73
What are some important side effects of methotrexate? and what advice would you give to someone starting the drug?
Bone marrow suppression Mucosal damage Pulmonary fibrosis Hepatic cirrhosis To be taken once a week If they develop: - sore throat (immunosuppression) - jaundice they should seek medical attention Contraception Folic acid supplements
74
What are the side effects of omeprazole
Headaches Reduced defence against pathogens - C. Diff Hypomagnesemia - Tetany Osteoporosis - in elderly **avoid with clopidogrel

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