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Pharmacology/Toxicology Flashcards

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1
Q

Drug induced thrombocytopenia

A

Quinine

Abciximab

NSAIDs

Furosemide

Abx - penicilins, sulphonamides,
rifampicin

Anticonvulsants - Carbamazepine, Valproate

Heparin

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2
Q

Carbon monoxide affect on O2

A

Causes decreased O2 saturation of Hb - - > LEADS TO EARLY PLATEAU

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3
Q

Ciclosporin side effects

A

EVERYTHING INCREASED:

BP
Gums
Hair
K+
Fluid
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4
Q

Pharmacokinetic terms :

Half life

Volume of distribution

A

Half life = time taken for plasma drug conc to decrease by half

Volume of distribution - calue that descibes the extent at which a drug is retained within circulation or distributed elsewhere.

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5
Q

Pharmacodynamic termsL:

Efficacy

Emax

Potency

A

a measure of drug effects in a particular symptom

Emax - maximal effect - partial agonist Emax < Full agonist

Potency: Expresses drug efficacy in relation to dose/conc.

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6
Q

Pharmacokinetics - Metabolism

A

2 types of biochemical rxn:

Phase 1:

  • oxidation/reduction/hydrolysis.
  • P450
  • toxic/reactive product

Phase 2:

  • Conjugation
  • products less reactive
  • typical groups - glucoronyl/acetyl/methyl/sulphate

1st pass metabolism:
- Drug is extensively etaboliused before reaching systemic circulation.
in LIVER
- ASA, verapamil, GTN, Propanolo, ISMN, hydrocortisone, testosterone

Zero-order kinetics:

  • Metabolism is independent of drug conc.
  • Metaboplic pathway= saturated
  • Phenytoin, ASA, Heparin, Ethanol
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7
Q

Drug induced lupus

A

Assoc with Acetylation and HLA-DR4

Ft:

  • butterfly rash
  • myalgia
  • pleurisy

Causes:

  • PROCAINAMIDE
  • HYDRALAZINE
  • others: isoniazid, phenytoin, minocyclione

Inx:

  • ANA +,/ dsDNA -
  • anti-histone Ab
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8
Q

Liver inducers/inhibitors

A

inducers - stop warfarin - PCBRAS
- Pghenytoin/carbamezapine/barbituates/rifampicin/alcohol/St Johns wort

Inhibitors - inc warf - AODEVICES
- allopurinol/omeprazole/disulifram./erythromycin/valproate/isoniazid/ciproflox/ethanol/sulfonamide

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9
Q

Fx of COCP

A

decreased absopriton - e.g. diarrhoea

Liver inducers

Con-comitant broad-spec Abx

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10
Q

drugs to avoid in pregnancy

A

Earyl - teratogenics:

  • Li - cardiac abnormalities
  • ACEI/ARBs - oligohydraminos
  • phenytoin - cleft lip/palate
  • Na Valp - NT Defects/spina bifida
  • Warfarin

Late preg –> X placents:

  • Carbimazole –> neonatal goitre
  • Gentamycin - CN8 deafness
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11
Q

prescribing in BReastfeeding

A
  • Amiuodarone
  • n Cytotoxics
  • Gold
  • Indometacin
  • Li
  • Iodides
  • OEstrogens
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12
Q

Liver Fx

A

Increase susceptible to sedatives/ drugs taht cause encephalopathy

Thiazide/loop diuretics –> hypokalaemia –> Encephalopathy

Rifampicin - accumulates as excreted in bile
Hypoalbuminaemia –> Phenytoin toxicirty
Poor clotting –> Warfarin leads to bleed
NSAIDs - Inc NA/H2O retention

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13
Q

Cardiology drugs

A

Abciximab - glycoprotein 3a/2b inhibitor –| platelet aggregation

Adenosine - activates K+ in SAN/AVN - CI - Asthma

Aliskiren - Direct renin inhibitor - used in essential HTN
- S.e High K+

Amiodarone:
- prolongs refractory period
- long half life
- give IV - effect hrs
- PO effect = weeks
- it is the LEAST NEG INOTROPIC ANTIARRHYTHMIC
\s.e. - CHIPCHANGE - cutaneous photosensitivity/hep dysfn/inc LDL/pulm fibrosis/CNS/hypo/hyper-thyrid/asx corneal deposits/neuropathy/GI effect/ Enhanced warf and dig

ACEI:

  • CI - BL RAS
  • S.e. - dry cough/hyperkalaemia/hypersesnsitivity

Clopidogrel:

  • Inhibits ADP bindiong site on platelet - stopp aggregation
  • P2Y12
  • longer anti-plt than ASA –> bleeding risk for 7/7

Digoxin:

  • Slows AVN conduction –> Blsacks Na/K+ ATPasa pumo
  • eliminated by KIDNEYS
  • S.e. –> Gynaecomastia

Flecainide:

  • class 1c anti-arrythmic
  • avoid if IHD/structural heart dx

Statins:

  • HMG CoA reductase inhib –> inhib RLS of cholesterol synth
  • S.E. - myopathy/drug induced hepatitis

Ivabradine_

  • Funny current blocker - inward NA-K channel - found in SAN
  • S.e - visual effects, headache, bradycardia/HB

Nicorandil:

  • V.D. used in angina
  • activates K+ Channels –> inc. cGMP
  • S.E. - headache, flushing, ulceration
  • CI - LVF

Pasugrel/Tocagrelor:

  • P2Y12 receptor inhibitor
  • use Ticagrelor in ANY NSTEMI
    s. e. - bleeding/ brady + inc SOB (ticagrelor)

Thiazide:

  • hypo Na/K/Mg
  • hypochloraemic acidossis
  • postural hypotension
  • agranulocytosis
  • pancreatitis
  • thrombocytopenia
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14
Q

Digoxin toxicity

A
  • reverse tick
  • arrythmias
  • confusion
  • yellow-green vision

precipitants:

  • hypokalaemia - competively competes with dig
  • low MG / High Ca
  • Inc Age/ RFx/
  • MI
  • Drugs 0- amiodarone/verapamil/ dilitiazerm

Mx:
[- Digi-bind
- correct arrythmioa
- Monitor K+

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15
Q

Endocrinology - Drugs

A

Carbimazole:

  • inhibits peroxidase enzyme
  • Agranulocytosis
  • X placenta –> neonatal goitre/hypothyrpoid.

HRT:

  • reduces bone fracture
  • inc breast Ca

NAteglinide/repaglinide:

  • INCREASE INSULIN secretion
  • similar mechanism as SU
  • good for postprandial hyperBGL as short 1/2 line
  • S.e> - GI Upset/hypersensitivity rxn
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16
Q

GAstro - drugs

A

S-ulfasalazine:
- S- afe in oregnancy ]- pro -drug of 5-ASA –> dec neutrophil chemotaxis/lymphocyte prolif/pro inflamm cytokines.
- cuation w/ G6PD deficiency or allergy to aspirin/sulkphonamides.
S.e. - oligospermia/SJS/ pneumonitis/lung fibrosis. myelosupression/heinz body anaemia/ coloured tears

Mesalazine/Osalazine:

  • types of 5-ASA
  • S>E - GI Distrubance / headache/pancretitis

Orlistat:

  • Inhibits pancreatic lipase
  • used ij obesity if BMI >30 or BMI > 28 + RF or cont WL
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17
Q

PArkinsons meds - See neuro notes

A

MAO-B inhib - Selegline

Amantadine - inhibit reuptake of DA

L-DOPA

  • absorbed in prox. small bowel - decr. if AA present
  • prodrug
  • netabolised by COMT
  • S.e. - Arrythmia/dyskinesia/post lowBP /psychosis/somnolescence

DA-R agonisst:

  • Carbegoline/bromocriptine/apomorphine/ropinerole - less dyskinesia vs L-DOPA
  • inc neuro psych s.e. ]
  • pulm/retroperitoneal fibrosis
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18
Q

Epilepsy meds

A

lamotrigine

  • inhibits glutamate
  • s.e. mood change/mavulopapular rash/influenza symptoms/SJS

Gabapentin:
- GABA isomer

Leviteracetam
- presynaptic GABA release

Vigabatrin
- irreversible inhib of GABA transaminase –> inc GABA activity

BZD:
- inc affinity for GABA to bind to it’s receptor

Carbamezapine:

  • derivative of TCA:
  • HEadache/diplopia soon after starting ]
  • morbilliform rash
  • toxic epidermal necrolysis
  • AGRANULOCYTOSIS

Valproate - S.e = V.A.L.P.R.O.A.T.E

  • Vomitting/allopecia/liver toxicity/pancytopaenia or pulm fibrosis/ retention of fat = wG/ pedema/ataxia/ teratogenic or tremor/ enzyme inhib.
  • AGRANULOCYTOSIS

5 HT - agonist:
- Triptans
- used in acute migraine
0- do not give in 24 hr of hemiplegic migraine or egotamine –> Vasospasm
- S.e. - chest paibn, flushing, drowsiness, vasospasm

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19
Q

Rheumatology drugs

A

MTX:

  • Folate agonist - inhibits dihydrofolate mediators
  • 1st kline in RA
  • S.e. - Pulm fibrosis /mucositis/myelosupression.pneumonitis/liver fibrosis
  • m Preg - avoid for 6/12
  • monitor FBC/U+E/LFT - @ start –> wkly until stable –> every 2-3/12
  • interactions - Trimethoprim/co-trimoxazole –> marrow supressionm
  • ionteractions - high dose ASA –> inc toxicity
  • MX toxicity with folic acid

Allopurinol:

  • Inhibits xanthine oxidase –> stops purne synth
  • inc risk of acute attach on commencent
  • can cause accum of azathiprine
  • decrease clearance of cyclophosphamide

Colchicine:

  • Inhibits macrophage migration
  • s.e. –> diarrhoea

Febuxostat:
- Xanthine oxidase inhibitor.

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20
Q

TOXICITY BEAR

A

LOOK UP PIC

Azathiprine - neurotoxic 
Cisplatoin - ototoxic and nephrotoxic 
Doxyrubicin - Cardiotoxic 
PSI - cyclophosphamide - bladdeer toxic 
 MTX - Nephrotoxic/myelosupression 
Vincristine - periph neuropathy 
Vincristine 0- periph neuropathy
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21
Q

Retinoids

A

usewd in sev psoriasis/acne

Teratogenic --> NT Defect 
0
S.e.: - Benign IHH
- dry mucus memrban e
- PHOTOSENSITIVITY 
- decreased night vision
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22
Q

Strontium

A

used in post-menopauesal osteoperosis

S.e.:
- Sev Allergy
DRESS - drug rash w/ eosinophillia and systemic sx

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23
Q

Spec drug adverse effects

A

Amennorhgea:

  • DA block - chlorpromazine, cimetidine
  • Na Valproate

Bronchospasm

  • ASA
  • BSAIDs
  • Adenosine
  • beta blkocker

Dyskineasia:
- L- DOPA > other antiparkinsons

Gynaecomastia:

  • OEstrogen like - Dig/ spiro
  • anti-androgen –> LHRH analogue/cimetidine
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24
Q

Drug induced liver dx

A

Heoatocellular:

  • Paracetamol
  • Valproate
  • MAOI
  • Halothane
  • anti-TB - R.I.P
  • statins
  • Alcohol/amiodarone
Cholestasis:
- COCP
- Fluclox / erythomycin / co-amox 
- anabolic . steroids
- chlorpromazine/promethazine
-

Liver Cirrhosis

  • MTX
  • amiodarone
  • methyldopa
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25
drug provoked myasthenia
``` amenoglycloside beta block phenytoin penicillamine procaiamide lidocaine ```
26
drug induced photosensitivity
``` Amiodarione Tetracyclines RETINNOIDS PSoralen Cipro ```
27
drug induced vasculiuti s
``` allopurinol \Catopril Cimetidine LTRA penicillin ```
28
acute pancreatitis - drug causes
``` antiretrovirals azathiprine corticosteroidn fibrates statins thiazides ```
29
SIADH - derug causaes
Carbamazepine chlorpropamide cytotoxic
30
PAracetamol OD
liver normally conjugats paractamol + glutathione in OD --> saturated --> all glutatjione used. Therefore get oxidation of P450 mixed fn oxidases. --> toxic metabolite = N- Acetly - B - Benziquinoneimine. Mx: - <1hr --> aCharcoal - >1hr/staggered --> NAC - at 4hrs if level >100 --> NAC - @15hrs >15 --> NAC S.e of NAC: - Anaphylactoid rxn --> STOP and restart @ SLOWER rate. Kings college criteria: - Arterial pH <7.3 or All of : - Cr >300 - PT <100 - Encephalopath grade 3/4
31
TCA OD
Amitriptyline + dosulepin Early sx: - dry mouth - blurred vision - sinus tachy - agitation - blurred pupil Ft of sev poisoning: - Arrythmias - Seizures - Metabolic acidosis - Coma ECG Changes: - Tachy - Wide QRS - >100 - seizures >140 --> VT - prolonged QT Mx: - IV NaHCO3- - IV lipid emulsion
32
Throphylline toxicity
Sev acidosis Tachy Hypokalaemia LOC/seizures/confusion MX: - Rpt aCharcoal - IVI - Electrolyte - if level >60 !!! --> HAEMODYALISis
33
CO Poisoning
PX - >1 person from samew hosue px with flu-like sypmpotoms --> then get: - pounding headache - cherry red skin - N.V - Fatigue - FALSELY HIGH PO2 CO + Hb --> Carboxyhaemoglobin = MEASURE Carboxy-Hb ;evels: - <3% normal - 3-10% = smokers - 10-30% = symptoms - >30% = severe Mx: - 100% O2 - Hyperbaric O2 indications for hyper baric OR: - LOC - neuro signs - MI/arrythmia - Pregnancy
34
Quinine toxicity
Anticholinergic + Direct neurotoxic --> BLINDNESS prolonged QT alpha blocjk --> HGYPOTENSION TINNITUS SEV METAB ACIDOSIS
35
Pb Poisoning
Think if ABDO PAIN + NEURO SIGNS also get blue lines on lid margin Inx: - Blood Pb >10 - microcytic anaemia Mx = chelating agent: - DMSA - D-penicillamine - EDTA
36
Ecstasy poisoning
``` Agitation ]sweating ]tachy dilated pupils htn hypoNa hgih temp rhabdomyolysis ``` Tx: - supportive - if Temp very high depsirt supportive --> Dantrolene
37
Mercury poisoning
``` blindness hearing loss parasthesia RTA irritabilty ```
38
cyanide poisoning
inhibits Cytochrome C ocidase --> inhibits mitochondrial e- chain Brick red skin + smell of bitter almonds Mx: - 100% O2 - HYDROXOCABALOMIN
39
Methanol poisoning
DRUNK + VISUAL problems Mx: - Fomepizole or ethanol - Haemodialysis
40
insecticide poisoning
Inhibits scetylcholinesterase --> inc cholinergic side. effects Ft - SLUD - salivation - lacrimation - urination - diarrhoea Mx - Atropine
41
Ethylene glycol toxicity
USed coolant/antifreeze Ft of toxicirty: - stage 1 - like being drunk - 2 - metab H+ with inc anion gap - 3 - ac ute renal fx Mx: 1) Fomepizole 2) Ethanol/HD
42
Drug causes of photosensitivity
``` Thiazides Tetracycline, cipro, sukphonamides Amiodsrone Nsaids Psoralen Sulphonylureas ```
43
Which drugs are assoc wuth acetylator status
``` Procainamide Hydralazine isoniazid sulfasalazine dapsone ```
44
Drugs that exhibit Zero Order Kinetics
Phenytoin Salicylates Heparin Ethanol
45
Kings collecge criteria for liver transplant in paracetamol OD
At 24 hours: pH <7.3 or all of: PTT >100 secs Cr >300 Grade 3 or 4 encephalopathy
46
Causes of raised anion gap acidosis: | CAT MUDPILES
C - Cyanide/ CO A - aminglyclosides T- theophylline/toluene (glue) M - MEthanol U - Uraemia D - DKA/ starvation KA/ Alcoholic KA P - paracetamol/acetoaminophen I - Isoniazid/inborn error of metab/ IRon L - LActic acidosis E - Ethanol/ethyene glycol S - Salicylates/ASA/Aspirin
47
Drugs that cause photosensitvity: SAT
Sulphonamides Amiodarione Tetracycline
48
Adrenoreceptor anatg
Apha - 1 = Doxazosin Alpha - 1a = Tamsulosin Alpha (non-selective) = phenoxybenzamine beta - 1 = Atenolol (A for 1) non-selective beta = propanolol
49
Drug induced impaired glucose tolerance
``` Thiazides/ Steroids tacrolimus/ciclopsotin IFN-alpha nicotinic acd antipsych ```
50
Contraindications to COCP
``` Migraine with Aura >35 and smoking >15/day BP persitent >160/95 maj surgery secondary raynauds SLE w/ Anti-phospholipid BReast Ca <6/12 Post-partum and breastfeeding. ```
51
When to check phenytoin levels after a dose change
2 Weeks. Half life of phenytoin = 22 hours. Can take 5 - 14 days to reach a steady state. 10 - 20 = range for therapeutic
52
SIADH Drug causes: SIADH Causes Poor Voiding
ssri/indomethacin/antidepressants (TCA)/diuretics - furos/bendro C CARBEMAZAPINE/cyclophosphamide/chlorpromazine P - phenothiazine V- Vincristine/vinblastin
53
Pseudomembranous collitis
Cephlasporin >clinda >cipro
54
Drugs and Vision 1) Blue 2) Colour viision 3) haloes + Photosensitivity 4) Yelolow 5) Red/green affected
1) Viagra - blue pill 2) Chloroquine 3) Amiodarone 4) Dig 5) Isoniazid
55
Olyguric Crisis - causes and management
``` Neuroleptics - onlanzapine + haloperidol Metoclop Domperidone Carbamexapine chlrooquine ``` Mx: - IV Procyclidine others = benzhexol/benzadyle
56
Anti- HTN in preg
Methyldopa/labetolol/hyrdalazine late pref --> Nifedipine
57
Acquired AIHA
methyldopa penicillin quinine quinidine
58
Highly protein boudn drrugs
ASA/warf/phenytoin/digitoxin/valroate/nifedipine/propanolol/verapamil Increased action in low alb states ---> unbound drug leads to action
59
why do you get nitrate tolerance with GTN use?
formation of reaction oxygen species
60
Theophylline toxicity
Ft: - Tachy/seizures/metabolic acidosis - Tremor - Vomit - Insomnia Mx: - acute tachy --> Esmolol - If arrythmia --< HAEMODYALISIS
61
Amitryptilline OD
Cant see pee spit or shit Acidosis Prolonged QT Mx: mild --> IVI Sev --> IV NaHCO3
62
Fruit + Drug interation
Inhibitors - Grapefruit + Seville orange --> Simvastatin/amlodipine/diazepam/nifedipine Inducers: Cranberry juice - doesnt affect statisn
63
Drug induced oedema
intermittent facial oedema = moxonidine PEripheral oedema = amlodipine Angioneurotic oedema - ace-I
64
drug induced prolonged QT
Sotalol/quinidine/procainamide/amiodarone Antipsych/domperidone/clarithromycin/erythromycin/cipro/trimethoprim/domperidone/cocaine
65
Hyper-PRL drugs
DA Antag - Phenothiazones/risperidone/metoclop DA Depleting - MEthyldopa/isoniazid/TCA/ Verapamil/Oestrogens
66
Antiaeeythmics
Type 1 - Na channel (Double Quarter pounder/ with Lettuce Mayo and Tomato/ and More Fries Please 1a = quinidine/procainamie/disopyramdie 1b = lidocaine.moxeletine/tocainide 1c=flecainids/propefenanone Type 2 - betablocker (Lol) Type 3 - K+ blocker (this is SAD) - Sotalol - Amiodarone - dofelitide Type 4 - Ca-channel blocker ( I and V in IV) - d-i-lt-i-azem - V-erapamil
67
Drug precipitant of psoriasis "NAAL man i don want psoriaisis
Nsaids/Atenolol/antimalarials/Li
68
BZD overdones
Managemengt - SUPPORTIVE +/- flumazenil (inc seizure risk)
69
Digoxin OD
Downlslope ST, Short QT and prolonged PR, U wave Mx: - HD unstable --> DC cardioverion Otherwise DIGIBIND Monitor K+ and renal fn
70
Warafrin in pregnancy
Stop in 1st 2/52 of preg and cover with lmwhh --> restart at 2/52 --> 3rd trimester stop and cover LMWH--> Start 2/52 psot=partum
71
Black triangle in BNF meaning
Recently added therefore must report advers affects = yellow card scheme
72
MEthanol poisoonig
Ft --> BLINDNESS Mx = Ethanol/fumepazole
73
Drug cause of dupyterns contracture
PHENYTOIN
74
Chloroquine toxicity
NAusea, headache, visual disturbance, arrythmia coma Hypoglycarmia interferes with cardiac NA channels --> PROLONGED QRS
75
MTX Interatcion
Trimethoprim and co-trimoxazole--> myelo supressopm Checl U+Es weekly --> sstable then every 2-3/12
76
Monoclonal Ab
``` Inrfliximab - anti-TNFa - RA/Crohns/CML Rituximab - CD20 - NHL/RA Cetuximab - EGFR - met colorectal ca/ Head + neck Ca Transtuzumab - HER2 - met breast Alemtuzumab - CD52 - CLL ```
77
Drug monitoring
Li - 12 hr post dose Dig - 6hr post dose Ciclosporin - immed b4 next dose ``` Phenytoin: - doesnt req reg monitor only if: ?toxicity ?compliance Dose change - Immed before next dose ```
78
Drugs that precipitate AIP
``` BArbituates BZD Halothanes EtOH OCP Sulphonamides ```
79
Heparin vs LMWH MOA
LMWH: - Activates antithrombin 3 --> FXa inhibition Heparin - Activates antithrombin 3 --> inhibits F9,10,11,12
80
Indications for NA Bicarb in TCA OD
Reduced consciousness QRS>100 Metabollic acidosis

MRCP (20 decks)

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