The calm before the storm (things I still can't remember) Flashcards
(128 cards)
1
Q
Dopamine agonists
A
Ropinirole
Pramipexole
Rotigotine
2
Q
Ergot derived drugs
A
Pergolide
Cabergoline
Bromocriptine
3
Q
SEs of ergot derived drugs
A
Cardiac valve fibrosis and other fibrotic syndromes
4
Q
What smoothes levodopa response in parkinsons
A
COMTi, MAOI
5
Q
What can improve neuropsych symptoms in parkinsons
A
Atypical neuroleptics, donepezil
6
Q
What can you use in crises in parkinsons
A
Apomorphine (sc)
7
Q
What is benzhexol’s role in parkinsons
A
younger patients with tremor (v limited)
8
Q
What do you use for acute dystonia inc oculogyric crisis?
A
anticholinergics
9
Q
What do you use for parkinsonian syndrome (neuroleptic side effect)?
A
Anticholinergics, dopamine agonists
10
Q
What can you use for akathisia?
A
Beta blockers
11
Q
What can you use for tardive dyskinesia?
A
Switch to atypical neuroleptic
12
Q
What can you use for neuroleptic malignant syndrome?
A
Dantrolene, dopamine agonists (may last for 7+ days after drug stopped)
13
Q
What is the side effect of vigabatrin?
A
Visual field defects
14
Q
Which anti epileptics are strong enzyme inducers?
A
Carbamazepine, phenytoin
15
Q
Which anti epileptics are weak enzyme inducers?
A
Oxcarbazepine, valproate, topiramate
16
Q
Which anti epileptics are susceptible to action of other enzyme inducers/inhibitors?
A
Lamotrigine, tiagabine, zonisamide
17
Q
For fatigue in MS give
A
Amantadine, modafinil
18
Q
For pain in MS give
A
Amitriptyline, pregabalin, gabapentin
19
Q
For spasticity in MS give
A
Baclofen, danrolene, diazepam, tizanidine, botox, physio
20
Q
For bladder disturbance in MS give
A
Oxybutynin, tolterodine, catheter
21
Q
For tremor in MS give
A
Clonazepam, primidone
22
Q
Antimuscarinic antiemetic and when do you give it
A
Hyoscine, for motion sickness
23
Q
Antihistamine antiemetic and when do you give it
A
Cinnarizine, cyclizine - motion sickness and vestibular disorders
24
Q
DA antagonist antiemetic and when do you give it
A
Metoclopramide, domperidone - post op nausea
25
5-HT3 antagonist antiemetic and when do you give it
Ondansetron - chemo and post op
26
Steroid antiemetic and when do you give it
Dexamethasone - chemo
27
Cannabinoid antiemetic is
Nabolone
28
Problems with lithium?
Nephrogenic DI, tremor, ataxia, hypothyroid, renal tubular acidosis (type 1), interacts with diuretics, needs monitoring
29
What are some typical antipsychotics
Haloepridol, perchlorphenazine
30
What are some atypical antipsychotics
Clozapine, olanzapine, risperidone, aripiprazole
31
What's the difference between 1st and 2nd gen antipsychotics
More extrapyramidal side effects with 1st gen. Weight gain, metabolic syndrome and diabetes with 2nd gen
32
SE of olanzapine
Cardiomyopathy
33
Medications associated with GORD
CCBs, nitrates, theophylline, bisphosphonates, steroids (including inhaled), NSAIDs, aspirin, clopidogrel
34
What's the problem with using H2 receptor antagonists in GORD and what are the names of some
Ranitidine, famotidine, cimetidine; tachyphylaxis (reduction of efficacy in 2-6 weeks)
35
Which H2 receptor antagonist is a strong inhibitor of CYP450
Cimetidine
36
Standard H pylori eradication regimen
PPI twice daily (normally omeprazole 20mg)
Amox 1g BD
Clari 500mg BD (if recent use of macrolide use metronidazole 400mg TDS)
37
Standard H pylori eradication regimen if penicillin allergic
PPI + clari 500mg BD + metro 400mg BD
38
NSAID with lowest risk of GI toxicity
Ibuprofen
39
5-ASA rare but serious side effect
Blood dyscrasias
40
Do you need to monitor azathioprine?
Yes
41
Most significant adverse effect of anti TNFalpha drugs?
Immunosuppression
42
What is infliximab rarely associated with which is very serious?
Life threatening hypersensitivity - have resus equipment when administering it
43
What can you give for abode pain in IBS?
Low dose TCA, SSRIs (unlicensed), peppermint oil capsules
44
How do you treat osteoarthritis?
Paracetamol + topical NSAID
If ineffective consider NSAID (unless on low dose aspirin in which case consider mild opioid)
Intra articular corticosteroids
45
How do you choose an NSAID?
Ibuprofen first line because it has lowest incidence of GI toxicity. If history of cardio disease give naproxen first line instead.
46
Which DMARDs are associated with blood dyscrasias?
Methotrexate, sulfasalazine
47
What SE is specific to hyroxychloroquine
Ocular toxicity
48
SEs of allopurinol
Itch, rash
49
SEs of colchicine
Abdo cramps, diarrhoea
50
Examples of alkylating agents
cyclophosphamide, chlorambucil, busulfan
51
Examples of antimetabolite chemo drugs
5-flurouracil, methotrexate, gludarabine
52
Examples of cytotoxic antibiotics
Doxorubicin, bleomycin
53
Examples of vinca alkaloids
Vincristine, vinblastine
54
Examples of taxanes
Paclitaxel
55
Examples of TK inhibitors
Imatinib, nilotinib
56
Examples of immunomodular chemo
Thalidomide
57
Examples of endocrine modulators used as chemo
Tamoxifen, anastrozole, cyproterone
58
SEs of cyclophosphamide
Haemorrhagic cystitis, BM suppression, alopecia (MESNA reduces incidence of cystitis)
59
SEs of doxorubicin
Cardiomyopathy, BM suppression
60
SEs of bleomycin
pulmonary fibrosis
61
SEs of vincristine
Peripheral neuropathy
62
SEs of paclitaxel
Hypersensitivity, peripheral neuropathy
63
SEs of 5-FU
Mucositis
64
SE of ondansetron
Constipation, headache, dizziness
65
What kind of antiemetic do you usually use for platinum chemo regimens?
Neurokinin 1 antagonists e.g. aprepitant
66
What are the common SEs of aprepitant
Hiccups, constipation and diarrhoea
67
What are the adverse effects of nabilone?
Drowsiness, euphoria, visual disturbances
68
What do you use amifostine for?
Reduce neutropenia and nephrotoxicity associated with cisplatin; protection xerostomia during head/neck radiotherapy
69
What do you use G-CSF for in chemo?
Reducing neutropenia (not used routinely)
70
SE of G-CSF?
Prolonged use -> myeloid malignancy
71
What do you use rasburicase for in chemo?
Prevention and treatment of tumour lysis syndrome
72
What is rasburicas?
Recombinant enzyme which metabolises uric acid to allantoin
73
What are the SEs of rasburicase?
Fever and hypersensitivity reactions
74
How do you treat neutropenic sepsis?
Culture (2 sets) and tazocin
75
SEs of codeine?
Constipation, drowsiness and rash
76
What is a small but serious risk of tramadol?
Serotonin syndrome when combined with other CNS drugs
77
What is the normal starting dose of morphine?
20-30mg daily
78
Common SEs of morphine?
Constipation, nausea, vomiting, dry mouth
79
How do you prescribe breakthrough morphine?
1/6 total daily morphine requirement, if needing >2 doses in 24h then increase background amount
80
What's the difference between oxycontin and oxynorm?
Oxycontin is sustained release, oxynorm is immediate release
81
Difference between oxycodone and morphine?
Oxycodone less constipating but can be more sedating
82
What do you have to be careful of with fentanyl?
x200 more potent. Significant risk of accidental overdose. Exposure to external heat significantly increases release from patch
83
Advantages of diamorphine?
Less nausea and hypotension
84
How do you convert PO morphine to IM or SC dose?
Half the dose
85
How do you convert oral morphine to syringe driver?
Divide by 3 for dose
86
What's the first line for trigeminal neuralgia?
Carbamazepine
87
SEs of carbamazepine?
Sedation and anti muscarinic side effects
88
What are the anti muscarinic side effects?
Dry mouth, blurred vision, constipation, urinary retention
89
SEs of gabapentin, pregabalin?
Dizziness, fatigue, drowsiness, weight gain
90
Management of hypertensive emergency?
Nitroprusside (+ beta blocker), monitor intra arterial BP, reduce mean BP by 15-25% in first hour, not more
91
Antidote to aluminium
Desferrioxamine
92
Antidote to arsenic
Dimercaprol, succimer
93
Antidote to beta adrenoceptor blockers
atropine, glucagon
94
Antidote to CCBs
atropine
95
Antidote to carbamate insecticides
atropine
96
Antidote to copper
D-penicillamine, unithiol
97
Antidote to cyanide
dicobalt edentate, hydroxocobalamin, oxygen, sodium nitrite, sodium thiosulphate
98
Antidote to diethylene glycol
ethanol, fomepizole
99
Antidote to digoxin
atropine, digoxin antibodies
100
Antidote to hydrogen sulphide
oxygen
101
Antidote to lead
sodium calcium edentate, DMSA
102
Antidote to methaemoglobinaemia
methylthioninium chloride (methylene blue)
103
Antidote to mercury
unithiol
104
Antidote to nerve agents
atropine, HI-6, obidoxime, pralidoxime
105
Antidote to oleander
digoxin antibodies
106
Antidote to organophosphorus insecticides
atropine, obidoxime, pralidoxime
107
Antidote to thallium
prussian blue
108
Treatment of SVT
Vagal manoeuvre, if not adenosine, if not verapamil, if not cardiovert
109
Treatment of status
Lorazepam or diazepam 1st line, diazepam rectally or midazolam via buccal mucosa, phenytoin if not successful
110
Treatment of acute severe asthma
```
Oxygen
Bronchodilators: salbutamol and ipratropium neb
Steroids
Consider continuous salbutamol
Add magnesium
Consider IV salbutamol or aminophylline
ITU
```
111
What combination of rate control drugs can you not give in AF
Diltiazem and beta blocker
112
What do you give for AF rate control?
Beta blocker or diltiazem or verapamil +/- dixogin
113
Treatment of CCF?
ACEI or ARB core treatment
Diuretic (loop) generally needed
Add low dose beta blocker: carvedilol, bisoprolol, nebivolol not atenolol
Add spiro (eplerenone)
Add digoxin usually in AF, otherwise for symptom control only
Nitrates can improve some symptoms
Can be added to hydralazine
114
Management of stable angina?
Aspirin/clopidogrel and statin
GTN might be enough
Beta blockers most effective prevention, diltiazem/verapamil if contraindicated
All contraindicated in LV dysfunction
Add long acting nitrate (ISMN) to beta blocker or CCB
Can add dihydropyridine to beta blocker
Consider nicorandil, ivabradine (causes severe brady), ranolazine
If persists think again about revascularisation
115
What can you add for hypertension after A + C+ D?
further diuretic, alpha blocker, beta blocker
116
Which antihypertensives can you use in pregnancy?
Methyldopa, hydrazine, nifedipine, labetalol
117
SEs of statins
Rhabdo, renal toxicity, GI disturbance, sleep disturbance, erectile dysfunction
118
Thyroglossal cyst
Located in the anterior triangle, usually in the midline and below the hyoid (65% cases)
Derived from remnants of the thyroglossal duct
Thin walled and anechoic on USS (echogenicity suggests infection of cyst)
119
Branchial cyst
Six branchial arches separated by branchial clefts
Incomplete obliteration of the branchial apparatus may result in cysts, sinuses or fistulae
75% of branchial cysts originate from the second branchial cleft
Usually located anterior to the sternocleidomastoid near the angle of the mandible
Unless infected the fluid of the cyst has a similar consistency to water and is anechoic on USS
120
dermoid cyst
Derived from pleuripotent stem cells and are located in the midline
Most commonly in a suprahyoid location
They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat
121
Cystic hygroma
Soft and transilluminates; most in posterior triangle
122
HbA1c target
6.0 if lifestyle only, 6.5 if lifestyle and metformin, 7.0 if any drug that might cause hypos
123
Vessel affected if Complete heart block following a MI?
Right coronary
124
Hypertension in diabetes, first line is
Ramipril regardless of age
125
pharm cardioversion in AF with structural heart disease
amiodarone (not flecainide)
126
What kind of BBB in ASDs?
Right
127
How does colorectal screening work
Faecal occult blood (FOB) test kits are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland
128
Sensory loss in syringomyelia
spinothalamic sensory loss (pain and temperature)
