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RAI - MRCP > Toxicology and Pharmacology > Flashcards

Toxicology and Pharmacology Flashcards

(94 cards)

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1
Q

What blood picture on a gas do you see in Aspirin OD

A

Metabolic alkalosis initially

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2
Q

What Juice does Warfarin Interact with

A

Cranberry Juice

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3
Q

What juice does Statin and Ciclospoin interact with the most

A

Grape Juice

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4
Q

What HLA type is S-J syndrome associated with

A

HLA-B1502

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5
Q

What is the best Mx of Neuroleptic Malignant Syndrome

A

IV fluids
Dopamine Agonist -Bromocriptine

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6
Q

What are the features of Local Anesthetic Toxicity

A

SAMS ( Slurred speech, Altered Mental Status, Muscle Twitching, Seizures)
Peri-oral tingling and numbness can also happen

Mx: 20% Lipid Emulsion ( Stat Followed by Infusion)

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7
Q

What are the key features of Ecstasy Toxicity

A

Hyperpyrexia
Rhabdomylosis
Kidney disease
Liver Failure
HTN

MX:
Benzodiazepine - agitation
IV fluids - Rhabdomylosis
IV Sodium Nitroprusside - HTN

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8
Q

Proximal myopathy with sensory neuropathy in someone being treated for gout.
What is the cause

A

Colchicine side effects

Note: Serum Creat Phosphokinase can be normal or elevated

Note:
Once drug is stopped, myopathy resolves, but sensory neuropathy remains

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9
Q

what is a note on PCM and Cyt. p450 inducers

A

Incudes worsen the effects of PCM as PCM gets metabolised and its metabolite NAPQI affects liver

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10
Q

What drug can cause Myasthenia Gravis

A

Penicillamine

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11
Q

what is the Mx of Paraqaut poisoning

A

Activated charcoal
Ideally witting 2 hrs, but effective within first 12 hrs

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12
Q

How do you measure bleeding risk in someone taking rivaroxban

A

Measuring Factor Xa

(rivaroxoaban is an inhibitor of factor Xa)

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13
Q

High Hb
Small Testes
Normal Axiallary and Pubic hair

What is your Dx

A

Androgen Abuse

Ix:
Low LH ***
Increases Testosterone : Epitosterone ratio ( >6:1)

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14
Q

What are the drugs causing Increased risk of pancreatitis

A

5-ASA, Azathioprine, Sodium Valproate, Furosemide, Oestorgen, Corticosteroids, Ocreotide, Metronidazole, Cimetidine, Cisplatin

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15
Q

ACE- side effect

A

Angioedema

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16
Q

What is the mx of Methahemoglobinameia

A

1) Methylene Blue
2) Ascorbic Acid

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17
Q

Hypokalemia
Hyperglycemia
Mild acidosis

in someone being treated for COPD

What is your Dx

A

Theophylline Toxicity

mX:
Multidose activated charcoal
or
Dialysis

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18
Q

Why do steroids cause Hyperglycaemia

A

Increase Gluconeogensis

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19
Q

What are the key features of neuroleptic malignant syndrome

A

Rgidity
Fever
Extra-pyramidal signs
Catatonia- Muteness
Increased Creat Phosphokinase
Increased AST
Urine Myoglobin

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20
Q

Which drugs can cause chronic urticaria

A

Aspirin, NSAID, Opiates

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21
Q

What drug should be stopped when starting azathioprine

A

Allopurinol

A both azathioprine and allopurinol cause myelosuppression and if used together can cause significant haematological toxicity

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22
Q

What is a normal anion gap

A

12-16

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23
Q

What anion gap do you see in methanol toxicity

A

Raised anion gap
with metabolic acidosis Resp compensation

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24
Q

Renal colic
Recent HAART for HIV

Which drug can cause nephrolithiasis

A

Nelfinavir

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25
How do you Tx Amitriptyline x OD
Sodium Bicarb
26
Post MI and Angioplasty, If pt.dvelops GI hemorraghe few in first few days and is on aspirin, clopi and Fonda What do you do
Stop Fonda only But continue Aspirin and clopi Note: If all 3 are stopped, high risk of stent thrombosis
27
IF Pt. is on Warfarin and now being considered an anti-depreesant Which would you choose
Mirtazepine Note: SSRI are contradincatd when ppl on warfarin as they enhance the effect of warfarin
28
is St. Jhons wart an inducer or inhibitor
Inducer
29
What is the mx of methanol or ethylene glycol poisoning
Fomepizaole Note: Both methanol and ethylene glycol poisoning cause raised anion gap with met. acidosis Note: In methanol poisoning, sometimes you can treat with IV ethanol as well
30
What group of drug is dothiepin
TCA
31
What is the side effect of Streptomycin
vestibular damage
32
What are the side effects of anti-tb drugs
Isoniazid - peripheral neuropathy ( due to Vitamin B6 depletion - Pyridoxine) Rifampin - Colour change of secretions Pyrazinamide- Joint pains, arhtraliga Ethambutol - Optic neuritis Streptomycin - vestibular damage
33
What are the key features of TCA Toxicity
Dry mouth Urinary retention Skin blistering Hyperthermia Ataxia Nystagmus Hyper-reflexia Arrhythmia ( widened QRS complex) Seizure and coma can occur Mx: Sodium Bicarb
34
What are Drug causing gynecomastia
Digoxin Spironolactone Ketoconazole Metronidazole Finasteride
35
Why does isoniazid cause peripheral neuropathy
( due to Vitamin B6 depletion - Pyridoxine)
36
Where do you use trihexiphenydil Hydrochloride ( Benzhexol)
Mx of Oculogyric crisis ( due to metaclopramide/ prochlorperazine)
37
What are the key features of aspirin ( Salicylate) OD
Hyperventilation Tinnitus
38
Which anticonvulsant causes irreversible visual field defects
Vigabatrin
39
How do you correct Torsades De Pointes
IV Mg Sulphate x 10mmol over 15 mins
40
How do you treat Pt.;s with beta blocker over dose where there is bradycardia and hypoglycaemia
1st- IV glucagon 2nd - If no response, then for pacing
41
How do you treat salicylate poisoning
1.26% of Sodium Bicarbonate If severe complications, then dialysis
42
what is the relation of TMPT and Azathioprine
Low or absence of TMPT, leads to excess cumulation of azathioprine levels and causes toxicity as it isn't metabolised
43
Which anti-HTN drugs is associated with erectile dysfunction
Beta blockers - such as Atenolol Switch to cardio-selective beta biker like bisoprolol or nebivolol
44
What is the mx of lead poisoning
DMSA - Dimercaptosuccinic acid Calcium edetate
45
What Is the mx of cyanid poisoning
Dicobalt Edetate x 300mg x IV - 1st Sodium Thisosulfate - 2nd NOTE : NOT sodium nitroprusside
46
Someone with Carbazemine OD, having multiple sizures How do you Mx
Trial Lorazepam If fails with lorazepam as well, the intubate and ventilate
47
Which anti-psychotic drug causes agranulocytosis
Clozapine
48
What are some of the drugs that cause Methaemoglobinameia
Trimethoprim Primaquine Sulphonamides Lidocaine Amyl Nitrate Chloroquine Dapsone Metoclopramide Phenacetin Anilyn Dyes
49
What drugs can cause sensorineural deafness
Gentamicin Vancomycin Erythromycin
50
What are the indications to use anti-venom after a snake bite
>Persistent Hypotension >Lower limb oedema ascending 2-4 hrs post snake bite >WBC> 20 >ECG abnormalities > Vomiting > Hemostatic changes Note: Mere presence of snake bite venpecture does nOT indicate anti-venom use NOte: Antivenom use has 1% risk of anaphylaxis
51
What are the indications for digibind use
> Hemodynamic instability > Life threatening arrhythmias > K >5 > Plasma Dig levels >13nmol/l > Ingestion of >10mg of dix for adults and >4mg for children > Recurrent Bradycarida
52
What is the side effect of bleomycin
Pulm Fibrosis
53
What is the side effect of daunorubicin
Cardiomyopathy
54
What can occur with sodium Nitroprusside Overdose
Cyanide accumulation and toxicity
55
How d you treat drug induced ( Meotclopramide/ Prochlorperazine) dystonia/ truisms/Torticollis/ oculogyric crisis
Procyclidine
56
What additional test can you do when you are checking for anabolic steroid abuse and the blood test show; Testoetrone;Epitestostrone radio between 4:1 and 6:1
Carbon 13: Carbon 12 ratio Note: if Testosterone : epitestosterone Ratio Is; >6:1, it automatically confirm anabolic abuse
57
How can use test for EPO abuse
It can be tested in urine for a few weeks after injection
58
What is the criteria for Liver Tx in PCM Overdose
If Ph <7.3 or lactate >3 after adequate fluid resus OR if all 3 below present in 24 hrs > Creat >300 > PT >100 ( or INR >6.5) > Grade III/IV encephalopathy
59
what is the MOA of Methrotreaxate that causes pancytopenia and megaloblastic anemia
Inhibition of dihydrofolate reductase
60
Why should you not treat mixed OD of benzodiazepines + TCA or benzodiazepines + Other drugs with flumazenil
It can cause seizures
61
Paraquat poisoning Ix
1st - urine testing 2nd- If above raised, then confirm with serum levels
62
How do you reverse Methotrexate toxicity
Folinic Acid/ Calcium Folinate ( Leucovorin) Note: Please note, Folinic acid is NOT same a folic acid
63
Which Anti-HTn is safe to use with Lithium
CCB ( amlodipine) Note: ACE/ARB/ Diuretics can worsens toxicity of lithium
64
what can you use if someone has persistent VT in TCA x OD even after acidosis has been corrected with Sodium Bicarb
IV Lidocaine
65
What is the advice on thalidomide and family planning
Both sexes need to use contraception Will be cleared off system 1 week post stopping drug.
66
When do you use gastric lavage over activated charcoal in Aspirin poisoning
When OD is >500mg/kg
67
What is the Mx of Serotonin Syndrome
Cryoheptadine and propranolol
68
How do you treat Iron Overload
Parenteral Desferrioxamine NOT Oral ( as absorption is minimal to treat Iron Overload) Features: Abdo Pain Vomting GI blood loss Xray- show tablets in bowel
69
Which antiseptic is fairly safe in OD
Sodium Valproate
70
What are the features of theophylline OD
Arrhythmias Vomitng Confusion Seizures Electrolyte Changes; Hypokalaemia Hyperglycaemia Hypercalcaemia MX: Charcoal Hemoperfusion
71
What are the key features of GHB overdose
Also called as ; Liquid X, Easy Lay, Scoop, or GHB, Cherry meth Used by body builders to gain muscles and lose weight Tastes like Sea Weed Pt. can deteriorate rapidly and go into Resp depression and coma Can Spontaenously recover and even pull out Endo tracheal tubes after being ventilated!!! Met Acidosis Hyperglycaemia Hyperkalemia Hypernatremia
72
In which drug over-doses can multiple dose activated charcoal be used
Carbamazepine Theophylline Digoxin Dapsone Phenobarbitone Quinine
73
What are the features of Phenytoin Toxicity
Mental slowing Ataxia Cerebellar dysfunction Nystagmus
74
What is the Mx of CCB x overdose
Calcium Chloride infusion High dose insulin dextrose Atropine if bradycardia and hypotension
75
What is the Mx of Body packers with drugs
If asymptomatic - Laxatives If symptomatic - Surgical referral
76
What is the composition of Fomepizole
4-methypyrazole Note: If fomepizole not available in eythylene glycol poisoning and Pt. is acidotic with Ph <7.2 -> give 8.4% sodium bicarbonate
77
How do steroids use affect/cause osteoporosis
Affect/alter PTH secretion ( reduced tonic secretions and causes more used secretions )
78
What is the MOA of Phenoxybenzamine
Non competiive; Alpha receptro antagonist
79
What is the MOA of Prazosin/ Terazosin
competiive; Alpha receptro antagonist
80
What are th key features of Methanol poisoning
Blurred optic discs Raised anion gap Raised osmolar gap
81
Which anti-rheumatoid drug is your first preference In pregnancy
Sulfazalazine Azathioprine But if both in option, Sulfa is better
82
How do you reduce risk of hemorrghaic cystitis in Cyclophosphamide use
MESNA
83
Which Abx are safe in pregnancy and breastfeeding
Pencillin, Cephalosporins, Macrolides
84
What should you monitor when someone is on Azathioprine
FBC, U and E;s and LFT
85
What I the key in Gent dosing
If trough is high, increase interval If Peak is high, reduce Dose
86
How does rifaximin reduce encephalopathy
It reduced ammonia levels
87
Which antiemetics are safe in pregnancy
Promethazine and Cyclziine
88
Why does amlodipine cause Hypotension and Tachycardia
L-Type Calcium Blockade Remember Am'L'odipne
89
What is the side effect of Tetracycline in infants
Teeth Staining and impaired bone growth
90
Which drug can cause Hypertrichosis
Ciclosporin
91
What is a common interaction of verapamil with
Ciclosporin
92
What is the 1st line of Mx of serotonin Syndrome
Diazepam If no response then Cryohepatidine
93
Severe hyperthermia during intubation/anestheisa Raised Pco2 Jaw Spams Whats is your Dx and MX
Malignant hyperthermia Mx: Dantrolene and change anesthetic agent ( possibley to propofol) Causes: Halothane, Succinylcholine, Isfolurane
94
What re the effects of Amphetamine abuse
Similar features like schizophrenia

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