PSA revision Flashcards
1
Q
What are the enzyme inducers?
A
PC BRAS:
- Phenytoin
- Carbamazepine
- Barbiturates
- Rifampicin
- Alcohol (chronic excess)
- Sulphonylureas
2
Q
What does it mean by enzyme inducers - what happens to the concentration of the drug?
A
They increase the activity of enzymes and thus decrease the drug concentrations
3
Q
What does it mean by enzyme inhibitors?
A
They decrease enzyme activity and thus increase drug concentrations
4
Q
What are the enzyme inhibitors?
A
AODEVICES
- Allopurinol
- Omeprazole
- Disulfiram
- Erythromycin
- Valproate
- Isoniazid
- Ciprofloxacin
- Ethanol
- Sulphonamides
5
Q
What are the drugs that should be stopped before surgery?
A
I LACK OP
- Insulin
- Lithium
- Anticoagulants/antiplatelets
- COCP/HRT
- K-sparing diuretics
- Oral hypoglycaemics
- Perindopril (and other ACEi)
6
Q
How long before surgery should COCP/HRT be stopped?
A
4 weeks
7
Q
What are the side effects of steroid use?
A
STEROIDS
- Stomach ulcers
- Thin skin
- oEdema
- Right and left heart failure
- Osteoporosis
- Infection
- Diabetes
- Syndrome Cushing’s
8
Q
What is the fastest rate that IV potassium can be given?
A
10mmol/hour
9
Q
Why should cyclizine be avoided in patients with cardiac problems?
A
It can worsen fluid retention
10
Q
What are the first line medications for neuropathic pain?
A
- Amitriptyline 10mg PO nightly
11
Q
Which drug is known to cause hyperkalaemia and why?
A
ACE inhibitors e.g. ramipril or lisinopril - through reduced aldosterone production and thus reduced potassium excretion in the kidneys.
12
Q
Why do ACE inhibitors cause a dry cough?
A
They lead to a production of bradykinin via reduced degradation of ACE
13
Q
Why are you at risk of stomach uclers when taking ibuprofen?
A
Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection from acid.
14
Q
Why can ibuprofen also contribute to renal failure?
A
The inhibition of prostaglandin synthesis also reduces renal artery diameter and blood flow thereby reducing kidney perfusion and function
15
Q
Why is ibuprofen a bad choice for asthmatics?
A
It can cause bronchoconstriction
16
Q
If a patient is on methotrexate and has a UTI, which antibiotic should be avoided, and why?
A
Trimethoprim - as it is a folate antagonist and because methotrexate is as well, can cause bone marrow toxicity
17
Q
What is a side effect of calcium channel blockers, and the reason they should not be started in someone with heart failure?
A
They can lead to peripheral oedema
18
Q
If someone on warfarin is found to have an INR of between 5-8, but no bleeding, what is the guideline for management?
A
Stop warfarin for 1-2 days and reduce maintenance dose
19
Q
If someone on warfarin is found to have an INR of greater than 8, but no active bleeding, what is the management?
A
Stop warfarin until INR is <5, and give oral phytomenadione 5 mg (aka vitamin K)
20
Q
What are the two principal abnormalities to gain from assessing U&Es?
A
If there is an electrolyte disturbance and the performance of the kidneys based upon creatinine and urea
21
Q
In basic terms, if there are high neutrophils, what type of infection does this indicate?
A
A bacterial infection
22
Q
If neutrophils are low, or lymphocytes are raised, what type of infection can this classically indicate?
A
A viral infection
23
Q
Which drugs can cause neutropenia?
A
Clozapine and carbimazole
24
Q
What are the causes of SIADH?
A
SIADH
- Small cell lung tumours
- Infection
- Abscess
- Drugs (especially carbamazepine and antipsychotics)
- Head injury
25
The mnemonic DIRE can be used to remember the causes of hypokalaemia. What does it refer to?
DIRE
- Drugs - loop and thiazide diuretics
- Inadequate intake or intestinal loss e.g. diarrhoea/vomiting
- Renal tubular acidosis
- Endocrine (Cushing's and Conn's syndromes)
26
The mnemonic DREAD can be used to remember the causes of hyperkalaemia, what does it refer to?
DREAD
- Drugs - potassium-sparing diuretics and ACEi
- Renal failure
- Endocrine (Addison's disease)
- Artefact (very common, due to clotted sample)
- DKA
27
A raised urea can indicate kidney injury, but what else can it indicate, especially in someone with a normal creatinine?
An upper GI bleed
28
What are the pre-renal causes of AKI - accounting for 70% of AKIs?
1. Dehydration of any cause e.g. sepsis, shock, blood loss
| 2. Renal artery stenosis
29
What are the two types of toxicity caused by gentamicin and vancomycin?
Ototoxicity and nephrotoxicity
30
In patients with Addison's disease, if they develop an infection, which drug is important to increase the dose to provide adequate response to the increased stress?
Corticosteroids e.g. hydrocortisone
31
For the treatment of epilepsy, the type of seizure determines the drug choice. What is the first choice for a generalised tonic-clonic seizure?
Sodium valproate
32
What is first line for absence seizures?
Sodium valproate or ethosuximide
33
What is first line for focal seizures?
Carbamazepine or lamotrigine
34
What are the side effects of sodium valproate? (3 T's)
Tremor
Teratogenicity
Tubby - weight gain
35
What is the usual treatment for someone with mild Alzheimer's?
AChE inhibitors - acetylcholinesterase inhibitors
36
What are the three licensed drugs for Alzheimers? (3)
1. Donepezil
2. Rivastigmine
3. Galantamine
37
For the treatment of Crohn's disease. what is used to induce remission?
Steroids - prednisolone or if a severe flare up then hydrocortisone
38
What is the treatment for maintaining remission in Crohn's disease?
Azathioprine or 6-mercaptopurine
39
What is the usual treatment for rheumatoid arthritis?
Methotrexate and a DMARD e.g. sulfasalazine or hydroxychloroquine
40
If rheumatoid arthritis fails to respond to the usual drugs and two DMARDs have been tried, what can be tried?
Infliximab or TNF-alpha inhibitor
41
Which laxative is good for faecal impaction?
A stool softener e.g. sodium docusate
42
Which laxative is a stimulant?
Senna
43
Which laxative is osmotic?
Lactulose
44
If a woman being treated with ACEi for hypertension wishes to conceive, which drug should she be switched to?
Labetalol
45
Why are weekly blood tests required when a patient takes methotrexate?
They are at risk of neutropenia
46
What can long-term steroid use increase the risk of?
1. Diabetes
2. Gastric ulcers
3. Hypertension
4. Addisonian crisis if stopped suddenly
47
What should potentially be given to patients alongside long-term steroid therapy who are older?
Bisphosphonates to prevent osteoporosis
48
What advice is important to give to someone starting on bisphosphonates?
The tablets should be swallowed with a full glass of water and the patient should remain upright for 30 minutes afterwards to prevent gastric side effects. Additionally the drug is taken once weekly and food needs to be avoided for up to two hours after taking the tablet as it reduces its absorption.
49
In someone with Factor V Leiden, experiencing a DVT and haemoptysis. What would be the first line treatment?
A LMWH - e.g. daltaparin at a treatment dose e.g. 15000 units S/C
50
What is the appropriate first line treatment for chronic heart failure in someone who has asthma?
An ACE inhibitor e.g. ramipril
51
What is the first line rate control treatment for someone with AF, who has asthma?
Calcium channel blocker - verapamil
52
When is metformin not a first line medication for patients with type 2 diabetes that is not controlled through diet and exercise?
If the patient is not overweight or if their creatinine is >150umol/L. If their creatinine is above this threshold, they are at risk of lactic acidosis.
53
When starting someone on a statin, what is important to test beforehand, and why?
LFTs - the liver metabolises statins and if AST/ALTs are raised more than 3 times the normal, they increase the risk of myopathy, as the liver impairment will increase the levels of statins as they won't be metabolised. Consequently the LFTs need to be checked before, at 3 months and at 12 months after commencing the treatment.
54
For the commencement of lithium medication, when is the sampling time recommended to check levels, after how long?
12 hours after the last dose
55
At what level for serum lithium concentrations is judged to be toxic?
>1.5mmol/L
56
Olanzapine can cause what side effect in patients, which requires a baseline test for what?
Can cause hyperglycaemia and diabetes, and therefore a fasting blood glucose must be tested at baseline and regular intervals thereafter
57
Why does a baseline CXR need to be carried out before starting someone on amiodarone?
As there is a risk of pulmonary toxicity
58
When someone is on a multiple daily dose regimen of gentamicin for endocarditis, what range should their serum concentration be?
3-5mg/l
59
Why is it important to monitor U&Es when someone is taking ACE inhibitors?
As they can cause hyperkalaemia, hyponatraemia and AKI
60
Why is it useful to monitor serum creatinine in someone taking digoxin?
As digoxin is excreted renally, so if there is renal impairment then there is an increased risk of toxicity
61
When someone is started on sodium valproate, what blood test is important to check first?
LFTs - valproate is associated with hepatoxicity and liver function should be measured at baseline as well as at regular intervals through the duration of therapy
62
What vitamin supplementation is usually required when someone is starting on valproate and why?
Vitamin D supplementation due to the risk of osteoporosis
63
If someone is started on clozapine, for how many weeks should they have weekly FBCs and why?
18 weeks, due to the risk of neutropenia and potentially fatal agranulocytosis
64
What are the side effects associated with ACE inhibitors?(4)
1. Hypotension
2. Electrolyte abnormalities (raised potassium)
3. AKI (but can help chronic renal failure)
4. Dry cough
65
What are the side effects associated with beta blockers? (4)
1. Hypotension
2. Bradycardia
3. Wheeze in asthmatics
4. Worsens acute heart failure (but helps chronic heart failure)
66
What are the adverse drug reactions associated with calcium channel blockers? (4)
1. Hypotension
2. Bradycardia
3. Peripheral oedema
4. Flushing
67
What are the adverse drug reactions associated with diuretics e.g. furosemide, bendoflumethiazide and spironolactone? (3)
1. Hypotension
2. Electrolyte abnormalities
3. AKI
68
What are the adverse reactions associated with heparins? (2)
1. Haemorrhage (especially if renal failure or <50kg)
| 2. Heparin-induced thrombocytopenia
69
What are the adverse drug reactions associated with warfarin?
Haemorrhage (ironically warfarin has a pro-coagulant effect initially as well as taking a few days to become an anti-coagulant, thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2)
70
What are the adverse drug reactions associated with aspirin? (4)
1. Haemorrhage
2. Peptic ulcers
3. Gastritis
4. Tinnitus (in large doses)
71
What are the adverse drug reactions associated with digoxin? (6)
1. Nausea
2. Vomiting
3. Diarrhoea
4. Blurred vision
5. Confusion and drowsiness
6. Xanthopsia (disturbed yellow/green visual perception including 'halo' vision)
72
What are the adverse reactions associated with amiodarone? (4)
1. Interstitial lung disease (pulmonary fibrosis)
2. Thyroid disease (due to its structural relation to iodine)
3. Skin greying
4. Corneal deposits
73
What are the early, intermediate and late side effects off lithium use?
Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, diabetes
74
What are the side effects associated with haloperidol?
Dyskinesias e.g. acute dystonic reactions, drowsiness
75
What is the side effect associated with clozapine?
Agranulocytosis
76
What is amiloride?
A potassium sparing diuretic, known to cause hyperkalaemia.
77
How does metformin work compared to sulphonylureas?
Metformin is a biguanide. It acts by limiting hepatic gluconeogenesis (creation of new sugar by the liver). Lactate is usually taken up in the process and without new sugar production in the liver it can build up leading to lactic acidosis. Sulphonylureas act by chemically squeezing insulin out of the pancreas.
78
Which drugs can significantly reduced lithium excretion and hence possibly lead to lithium toxicity? (3)
1. ACE inhibitors
2. Diuretics
3. NSAIDs
79
If a diuretic must be given to someone taking lithium, which one is the safest to use?
Furosemide (loop diuretics)
80
What is a 'polyuric phase'?
When a patient is recovering from renal failure and their urine output increases (which looks to be a good sign) but fluid input does not keep up, resulting in dehydration and electrolyte abnormalities. Urine output exceeding 200ml/h should always prompt consideration of this phenomenon.
81
What is the mnemonic used to remember the causes of hyperkalaemia?
```
DREAD
D - drugs
R - renal failure
E - endocrine - addisons
A - artefact
D - DKA
```
82
When is metformin not a first line drug for type 2 diabetes?
In someone with CKD and an eGFR <30ml and used in caution if <45ml/minute.
A sulphonylurea may also be considered if the patient is normal or underweight as metformin can suppress appetite
83
What are the drugs that can cause SIADH? (5)
1. Sulphonylureas
2. SSRIs, tricyclics
3. Carbamazepine
4. Vincristine
5. Cyclophosphamide
84
If a patient with AF and asthma is started on digoxin, what needs to be monitored?
Serum digoxin levels 6 hours after dose, and a ventricular rate at rest
85
Why should aspirin be avoided in woman who are breastfeeding?
Due to the risk of Reyes syndrome
86
What % of patients who are allergic to penicillin are also allergic to cephalosporins?
0.5-6.5%
87
Which antibiotic groups are known to be harmful in pregnancy?
1. Tetracyclines
2. Aminoglycosides
3. Sulphonamides and trimethoprim
4. Quinolones
88
Name some macrolides? (3)
1. Erythromycin
2. Azithromycin
3. Clarithromycin
89
Name some cephalosporins? (4)
1. Cefaclor
2. Cefalexin
3. Ceftriaxone
4. Cefotaxime
90
In addition to some antibiotics, which other drugs are not safe during pregnancy? (6)
1. ACE inhibitors, ARBs
2. Statins
3. Warfarin
4. Sulphonylureas
5. Retinoids (including topical)
6. Cytotoxic agents
91
Which antibiotics are safe to use while breastfeeding? (3)
1. Penicillins
2. Cephalosporins
3. Trimethoprim
92
Which antihistamine is given during anaphylaxis?
Clorphenamine
93
Gliclazides can cause patients to gain or lose weight?
Gain weight
94
Which group of antibiotics should be avoided in people with epilepsy and why?
Fluoroquinolones - known to rigger siezures or lower seizure thresholds
95
Which statin and what dose is first line for patients with established cardiovascular disease?
Atorvastatin 80mg
96
If the statin is being prescribed for primary prevention, which one and what dose is first line?
Atorvastatin 20mg
97
Which medications are known to exacerbate heart failure? (4)
1. Thiazolidinendiones (pioglitazone is contraindicated as it causes fluid retention)
2. Verapamil
3. NSAIDs/glucocorticoids
4. Class I antiarrhythmias - flecainide
98
Which blood tests are required as a baseline before starting quetiapine for psychosis? (8)
1. FBC
2. U&Es
3. LFTs
4. Fasting blood glucose
5. Fasting lipids
6. Weight
7. Blood pressure
8. Prolactin
99
What are the indications/clinical uses of bisphosphonates? (4)
1. Prevention and treatment of osteoporosis
2. Hypercalcaemia
3. Paget's disease
4. Pain from bone metastases
100
What are the adverse reactions caused by bisphosphonates?
1. Oesophageal reactions: oesophagitis, oesophageal ulcers
2. Osteonecrosis of the jaw
3. Risk of atypical stress fractures of the proximal femoral shaft
4. Acute phase response: fever, myalgia, arthralgia
5. Hypocalcaemia
101
What is the advice regarding taking bisphosphonates?
Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast. Patient should sit or stand upright for at least 30 minutes after taking tablet.
102
What is the recommended treatment for pulmonary oedema?
Furosemide 25-50mg IV once only (IM could be considered too)
103
What is the first line treatment for someone with hypoglycaemia and a GCS on 10/15?
20% glucose 50ml over 15 minutes. This would provided 10-20grams carbohydrate quickly. (If no venous access then IM glucagon)
104
What is the BNF guidance surrounding INR before surgery for patients normally taking warfarin?
If the INR is >1.5, then phytomenadione (vitamin K) needs to be given - 1 -5mg PO
105
When treating the pulmonary oedema with furosemide, what is the best indicator for how successful the treatment is?
The patients weight
106
What are the most serious side effects associated with cyclosporine?
Nephrotoxicity and hypertension which are thought to be mediated by vasoconstrictive effects on renal arterioles. Before initiation of treatment, a baseline assessment of renal function should be established and it is recommended that renal function is monitored every 2 weeks until results are stable. Blood pressure should also be monitored on a regular basis.
107
Which drug is first line for treating acute oculogyric/dystonic crisis as an adverse effect of neuroleptic medication?
Procyclidine hydrochloride
108
When is chemical cardioversion not indicated for someone presenting with new onset AF?
In patients who are older and who are presenting later than 48 hours from onset - due to the risk of thromboembolism. Additionally if there are structural heart defects then flecainide is contraindicated.
109
What is important to monitor when being treated with digoxin?
U&Es due to digoxin being renally excreted. Patients with renal dysfunction are more at risk of toxicity.
110
What needs to be checked before starting someone on valproate? (aside from pregnancy stuff)
Liver function needs to be tested as a baseline as it is associated with hepatotoxicity
111
When is enoxaparin dose adjusted? (2)
1. Adults <50kg
| 2. eGFR <30mL/min
112
Hepatic encephalopathy - look this up
Lactulose
113
Why is simvastatin contraindicated in pregnancy?
Congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development
114
When taking a statin, what needs to be monitored at baseline, 3 months and 12 months?
LFTs
115
What blood tests need to be monitored 6 monthly for patients on amiodarone?
LFT and TFT
116
What blood tests need to be monitored 3 monthly for people on azathioprine?
FBC and LFTs
117
For people taking lithium, which blood tests need to be monitored 6 monthly? (as well as before treatment and weekly when stabilising dose)
TFTs and U&Es
118
Which two cardiovascular drugs should never be prescribed together due to the risk of life-threatening bradycardias?
Beta-blockers and verapamil
119
Which drugs should be used with caution in patients with asthma? (3)
1. NSAIDs
2. Beta blockers
3. Adenosine
120
Which drugs are known to exacerbate psoriasis? (6)
1. Beta blockers
2. Lithium
3. Antimalarials
4. NSAIDs
5. ACE inhibitors
6. Infliximab
121
Which drug, sometimes used in the treatment of AF, is contraindicated in people with structural heart disease?
Flecainide
122
Which drugs are known to worsen seizure control in patients with epilepsy? (6)
1. Alcohol, cocaine and amphetamines
2. Ciprofloxacin, levofloxacin
3. Aminophylline, theophylline
4. Bupropion
5. Methylphenidate
6. Mefenamic acid
123
In someone on gentamicin TDS IV, if the trough levels are raised, how should their regime be managed?
Change it to BD, as opposed to lowering the dosage
124
Which drug is known to reduce the awareness of hypoglycaemia in diabetes patients?
Beta-blockers - as the symptoms are often anxiety, sweating, tachycardia and BBs can reduce this
125
What is the preferred steroid for mild/moderate croup and why?
Dexamethasone is first line as it has less mineralcorticoid activity than prednisolone.
126
Which drugs are known to cause SIADH?
1. Sulfonylureas
2. SSRIs, tricyclics
3. Carbamazepine
4. Vincristine
5. Cyclophosphamide
127
If a woman is started on tamoxifen what information is important to relay?
1. High risk of experiencing hot flushes
| 2. Increased risk of thromboembolism - be cautious of swelling in calves
128
When should people taking steroids withdraw gradually from the drug, rather than stopping it abruptly?
The BNF suggests gradual withdrawal of systemic corticosteroids if patients have:
received more than 40mg prednisolone daily for more than one week
received more than 3 weeks treatment
recently received repeated courses
129
What is the optimal anti-emetic choice for a patient with cardiac problems and electrolyte disturbances?
Cyclizine 50mg - check if the Q mentions QTc interval
130
What is the treatment of choice for shingles?
1. Aciclovir (800MG PO 5 times daily for 7 days)
2. Famciclovir
3. Valaciclovir
131
Ciclosporin and eplerenone are both known to cause what side effect?
Hyperkalaemia
132
What is the maximum daily dose of citalopram for elderly patients?
20mg
133
Alendronic acid and lansoprazole can both cause what side effect?
Loose stools/diarrhoea
134
Alendronic acid and prednisolone can both cause what GI problems?
Dyspepsia - alendrotnic acid is a direct irritant to the upper GI tract and symptoms are not improved by PPIs
135
Digoxin and beta blockers both cause what common effect?
Bradycardia
136
Amlodipine and naproxen both cause what side effect?
Ankle swelling
137
What is the difference in therapy for vulvovaginal candidiasis for a pregnant woman compared to not pregnant?
The therapy needs to be prolonged in therapy - normally it is just given as a single dose applicator, but in pregnancy it is clotrimazole pessary 100mg PV daily for 7 days (systemic therapy is not recommended in pregnancy)
138
Which antibiotic is indicated for repeated C.diff infections?
Vancomycin
139
What needs to be monitored regularly during ciclosporin use?
Kidney function - serum creatinine should be monitored every 2 weeks for the first 3 months, then monthly
140
When is the ophthalmic solution of cyclosporine used?
To help tear production in patients suffering from keratoconjunctivitis sicca
141
Liraglutide causes what common side effect?
Vomiting - GLP1 analogue frequently causes initial GI upset including nausea and vomiting
142
Which drug is known to precipitate serotonin syndrome?
Tramadol
143
What needs to be monitored when someone is started on the COCP after a month?
Blood pressure
144
What needs to be monitored before azathioprine is started?
Thiopurine methyltransferase (TPMT)
145
If someone on long-term morphine has AKI, what can their morphine sulphate be switched to if they are acute pain?
Substitute the morphine sulphate for oxycodone - it is metabolised by the liver to inactive metabolites, making it appropriate where strong analgesia is required in the setting on renal impairment
146
What is the treatment for warfarin reversal in severe bleeding and INR 10 (in addition to vitamin K)?
Dried prothrombin complex 50 units/kg IV once only
147
What should happen to the dose of amiodarone if a patient develops thyrotoxicosis?
Withhold the amiodarone
148
Which drugs can cause urinary retention? (particularly in the older population) (6)
1. Morphine/opiates
2. General anaesthetics
3. Benzodiazepines
4. NSAIDs
5. CCBs
6. Antihistamines
149
The INR of a patient who has recently started treatment for TB drops from 2.6 to 1.3. Which medication is most likely to be responsible?
Rifampicin - it is an P450 inducer and will therefore increase the metabolism of warfarin, therefore decreasing the INR.
150
If the INR of a patient on warfarin went from 2.6 to 6.5, and was recently started on treatment for TB. Which drug most likely caused it to happen?
Isoniazid - it is an enzyme inhibitor therefore decreasing the metabolism of warfarin
151
Which NSAID is contraindicated with any form of cardiovascular disease?
Diclofenac
152
What is digoxin's mechanism of action?
It inhibits the sodium/potassium pump
153
How does serotonin syndrome present?
1. Altered mental state
2. Hyperthermia
3. Hyperreflexia
4. Pupil dilation
154
Which drugs can lead to serotonin syndrome? (3)
1. SSRIs (and other antidepressants)
2. Ecstasy overdose
3. Amphetamine overdose
155
When should the antimalarial; mefloquine not be prescribed?
If there is a history of depression and/or anxiety
156
What are the side effects of ciclosporin? (8)
Everything is increased:
1. Hypertension
2. Hyperkalaemia
3. Gingival hyperplasia
4. Tremor
5. Hyperlipidaemia
6. Excessive hair growth
7. Nephrotoxicity
8. Hepatotoxicity
157
What is the classic side effects associated with pioglitazone? (4)
1. Increased risk of fractures
2. Weight gain
3. Fluid retention
4. Liver dysfunction
158
Which drugs can caused drug-induced lupus? (2)
1. Procainamide (antiarrhythmia)
| 2. Hydralazine
159
What 4 side effects can verapamil cause? (3 of which all CCBs cause)
1. Headache
2. Flushing
3. Ankle oedema
4. Constipation (only V)
160
What are the four side effects associated with beta blockers?
1. Bronchospasm
2. Fatigue
3. Cold peripheries
4. Sleep disturbances
161
What are the side effects associated with nitrates? (3)
1. Headache
2. Postural hypotension
3. Tachycardia
162
What are the side effects associated with nicorandil? (3)
1. Head ache
2. Flushing
3. Anal ulceration ...ouch
163
Which cardiac problem can lithium use in pregnancy cause to the unborn baby?
Ebstein's anomaly
164
Which TB drug is known to cause optic neuritis?
Ethambutol
165
What are the adverse affects associated with 5 alpha-reductase inhibitors e.g. finasteride? (4)
1. Impotence
2. Decreased libido
3. Ejaculation disorders
4. Gynaecomastia and breast tenderness
166
Which drug is used to reserve large doses of IV heparin used during cardiac bypass surgery?
Protamine sulphate
167
Which drugs exhibit zero-order kinetics? (4)
1. Phenytoin
2. Salicylates (e.g. high-dose aspirin)
3. Heparin
4. Ethanol
168
Why does heparin-induced thrombocytopenia occur?
It is immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin. Usually develops 5-10 days after start of treatment and it is classed as a pro-thrombotic condition.
169
What is the single most important factor for deciding if someone needs a liver transplant after paracetamol overdose? (i.e. which test needs to be most deranged)
If arterial pH is <7.3, 24 hours after digestion
```
or
all of the following:
1. Prothrombin time >100 seconds
2. Creatiine >300umol/l
3. Grade III or IV encephalopathy
```
170
Why must metformin be stopped following a myocardial infarction (acutely not long-term wise)?
Due to the risk of lactic acidosis
171
What may be seen on ECG of someone with a tricyclic overdose?
QRS widening
172
Which drugs should be avoided in renal failure? (5)
1. Tetracycline
2. Nitrofurantoin
3. NSAIDs
4. Lithium
5. Metformin
173
In someone with lithium toxicity presenting with seizures, after IV fluid, what is the next treatment step?
Haemodialysis
174
What is the antidote to tricyclic antidepressants e.g. amitriptyline overdose?
IV bicarbonate
175
Which antibiotic is known to lower the seizure threshold?
Ciprofloxacin
176
Which electrolyte abnormality predispose patients to digoxin toxicity?
Hypokalaemia
177
What do serotonin agonists treat?
Triptans - acute migraine
178
What do serotonin antagonists work ask?
Anti-emetics e.g. ondansetron
179
What kind of drug is required to work as a depolarising muscle relaxant used for rapid sequence induction?
Nicotinic agonist e.g. atracurium
180
When should allopurinol be started when someone presents with an acute attack of gout?
2 weeks after - as it increases the risk of gout in the long term
181
Which two drug groups are the most common causes of urinary retention?
Opioids and anticholinergics
182
Which form of morphine is safest to use for someone with renal failure but suffering acute pain?
Oxycodone (it is mainly metabolised by the liver)
183
What is the main mechanism of action of ondansetron?
5-HT3 receptor antagonist
184
What is a rare side effect of sitagliptin?
Pancreatitis
185
What is an early symptom of aspirin overdose?
Tinnitus
186
What type of drug is given to a woman admitted with psychotic delusions? (the mechanism of action of the group of drugs)
Dopamine antagonist
187
What type of drug is flumazenil?
GABA antagonist
188
What is the first-line treatment for someone with digoxin toxicity/overdose?
Administered digoxin-specific antibody fab fragments IV aka Digibind
189
What can metformin cause in patients with an impaired renal function?
Lactic acidosis
190
Which two diuretics should never be prescribed in concomitantly?
Amiloride and spironolactone - because they are both potassium sparing diuretics so puts the patient at high risk of hyperkalaemia
191
Which of the anti-TB dugs is known to cause peripheral neuropathy?
Isoniazid
