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Pharmacology- NS

Aspirin overdose Tinnitus, respiratory alkalosis, metabolic acidosis, hypoglycaemia, hyperthermia, dizziness, seizures, coma
First line treatment of HTN if >55/black CCB
First line treatment of HTN if <55 and white ACEi
Thiazide-like diuretic Chlorthalidone, indapamide, metolazone
Treatment of malignant HTN Atenolol, bendrofluthiazide, long-acting nifedipine, amlodipine- all PO
Treatment of aortic dissection Labetolol IV
Treatment of HTN encephalitis Labetolol IV
Step 1 of asthma management B2 agonists PRN
Step 2 of asthma management B2 agonists PRN + regular ICS
Step 3 of asthma management B2 agonists PRN + regular ICS + long-acting B2 agonists
Step 4 of asthma management B2 agonists PRN + regular high dose ICS + long-acting B2 agonists (or add methylxanthine/leukotriene antagonist)
Step 5 of asthma management B2 agonists PRN + regular high dose ICS + long-acting B2 agonists (or add methylxanthine/leukotriene antagonist) + oral steroids
Initial management of ACS Morphine Oxygen Nitrates Aspirin
Later management of ACS Clopidogrel (if for angio) LMWH ACEi Betablocker Statin
Drugs causing dyspepsia NSAIDs, aspirin, corticosteroids, CCB, bisphosphonates, nitrates, theophyllines
Use/mechanism for metoclopramide D2 antagonist (central and peripheral) Neoplastic disease, radiation, drug-induced vomiting, GA, cytotoxics. Not motion sickness.
Use/mechanism for ondansetron 5HT3 antagonist (prokinetic) Cytotoxic chemo, radiotherapy
Use/mechanism for cyclizine H1 antagonist Vestibular disorders e.g. vertigo, tinnitus, Meniere's, motion sickness
Use/mechanism for hyoscine bromide Anticholinergic Motion sickness, premedication, palliative care
Enzyme inducers Phenytoin Carbamazepine Barbituates Rifampicin Alcohol (chronic) Sulphasalzine/Smoking Sulphonylurea/St John's Wort Griseofulvin
Enzyme inhibitors Isoniazid Cimetidine/omeprazole Valproate Ketoconazole Esomeprazole SSRIs Sulphonamides Amiodarone Allopurinol
Thiazide mechanism of action Block Na-Cl cotransporter in distal tubule
Biochemical side-effects of thiazides Low- K, Na High- Ca, glucose, urate, lipids
Clinical side-effects of thiazides Polyuria, thirst, increased risk of gout, diabetes, erectile dysfunction
Loop diuretics mechanism of action Block Na-K2-Cl cotransporter in thick ascending limb
Biochemical side-effects of loop diuretics Low- K, Na, Cl, Mg, Ca (L for LOW) High- Urate, lipids
Clinical side-effects of loop diuretics Postural hypotension, increased risk of gout, rarely ototoxicity, renal failure (if + NSAID and ACEi)
Potassium-sparing diuretics mechanism of action Inhibit aldosterone-sensitive Na channel in distal tubule
Biochemical side-effects of potassium-sparing diuretics Low- Na, Mg, Cl High- K
Clinical side-effects of potassium-sparing diuretics Ataxia, drowsiness, gynaecomastia, sexual dysfunction, menstrual irregularities, rash
Drug causing RF- acts at efferent glomerular arteriole ACEi- Inhibits vasoconstriction, reducing capillary pressure
Drug causing RF- acts at glomerular capillaries Penicillamine- Increases permeability causing protein leak
Drugs causing RF- acts at proximal tubule Gentamicin, amphotericin B- Toxic to proximal tubule cells
Drug causing RF- acts at interstitium NSAIDs- Cause interstitial nephritis at high doses
Drug causing RF- acts at collecting duct Lithium- Causes nephrogenic DI by inhibiting effect of ADH on its receptors
Drug causes of photosensitivity Amiodarone (slate-grey), NSAIDs, thiazides, sulphonamides, tetracyclines (sunburn), chlorpromazine, nalidixic acid, retinoids
Local side-effects of steroids Skin thinning, striae, telangiectasia, pigment changes
Systemic side-effects of steroids HTN, fluid retention, diabetes, osteoporosis, proximal myopathy, psychiatric disturbance, pituitary suppression/Addisonian crisis on withdrawal, hypokalaemia, alkalosis, cataracts
Side-effects of retinoids Topical- erythema, photosensitivity Oral- chelitis, dry mucous membranes/eyes, hyperlipidaemia, myalgia/arthralgia, depression, teratogenicity
Drugs causing DI Lithium, demeclocycline, foscarnet, clozapine
Side-effects of amiodarone Pulmonary fibrosis, hypothyroidism (rarely hyper-), corneal deposits causing blue halo, optic neuropathy, LFT derangement and hepatitis, grey photosensitive rash
Metformin contraindicated at what eGFR? <30
How is digoxin cleared? Renally
Stop which drug before CT contrast? Metformin, withhold for 48h after
Drug causes of pulmonary fibrosis Amiodarone, bleomycin, busulfan, methotrexate, nitrofurantoin
Criteria for biologics in RA Trials of at least 2 DMARDs (one of which must be methotrexate) for 6 months each
Side-effects of methotrexate Mouth ulcers, nausea, deranged LFTs, teratogenesis, pulmonary fibrosis, pancytopenia
Side-effects of hydroxychloroquine Erythema multiformae, maculopathy (perform baseline eye exam)
Allopurinol and azathioprine can cause? Severe pancytopenia (xanthine oxidase metabolises azathioprine)
Mydriatic example and mechanism of action Tropicamide, atropine (antimuscarinics)
Side-effects of cyclophosphamide Haemorrhagic cystitis, cardiotoxicity, severe pancytopenia
Infliximab anti-TNF
Abxicimab anti-gpIIb/IIIa
Rituximab anti-CD20
Trastuzumab anti-HER2 (Herceptin)
Drugs causing gum hypertrophy Ciclosporin, phenytoin, nifedipine, other CCBs
Warfarin after 1st/2nd DVT/PE and whilst on warfarin 1st- INR 2-3 for 6m 2nd- INR 2-3 lifelong Whilst on warfarin- INR 3-4 lifelong
Warfarin with AF- stable and peri-cardioversion Stable- INR 2-3 lifelong Peri-cardioversion- INR >2 6w before and after
Warfarin with mechanical valve INR 3-4 lifelong
Side-effects of nifedipine Headache, peripheral oedema, gum hypertrophy, constipation
Side-effects of amphotericin B Nephrotoxic, fever, nausea, thrombophlebitis, haemolytic anaemia, hepatitis, hypokalaemia, enzyme inducer
Elevated plasma osmolarity in what OD? Ethanol, methanol, ethylene glycol
Features of digoxin toxicity Hyponatraemia, hyperkalaemia- leading to arrhythmias, prolonged PR, bradycardia, reverse tick ST segment, confusion, yellow halos in vision, nausea/vomiting, abdominal pain,
Definitive treatment of digoxin toxicity and indications Digoxin immune Fab Indicated if VT/VF/3rd degree HB, K >6, digoxin >7.8 6h post-OD
Antidote of arsenic Dimercaprol (chelator)
Antidote of benzos Flumazenil
Antidote of beta-blockers Atropine, isoprenaline, dobutamine, glucagon
Antidote of cyanide Dicobalt editate, sodium nitrate/sodium thiosulphate
Antidote of ethylene glycol/methanol Ethanol
Antidote of iron Desferrioxamine
Antidote of lead Dimecaprol, penicillamine (chelators)
Antidote of opiates Naloxone
Antidote of organophosphates Atropine, pralioxime mesylate
Antidote of paracetamol NAC
Antidote of thallium Prussian blue
Indicators of severe hepatotoxicity in paracetamol OD INR Also- abnormal LFTs within 12h, AST/ALT >10,000, hyperbilirubinaemia
Presentation of tricyclic OD Neuro- pyramidal signs, intranuclear ophthalmoplegia, seizures, hyperventilation Anticholinergic- dry mouth, blurred vision, urinary retention, hallucinations, dilated pupils Cardio- tachycardia, wide QRS, prolonged QT, VF/VT
Management of aspirin OD according to salicyclate level <4.3- increase fluid intake, monitor 4.3-5.1- alkalinisation of urine, correction of hypokalaemia prior >5.1- haemodialysis
Features of benzo OD Coma, sedation, nystagmus, ataxia, respiratory depression, hypotension
Features of CO poisoning Headache, dizziness, hyperventilation, hypotension, hyperreflexia, metabolic acidosis, rhabdomyolysis, non-specific chronic features e.g. headache
Drug causes of hypertrichosis Minoxidil, ciclosporin, diazoxide
Drug causes of raised prolactin Metaclopramide, domperidone Phenothiazines Haloperidor SSRIs, opioids (rare)
Monitoring of ACEi U&E at 0, dose increase and 12mthly Stop if >30% increase creatinine/K >5.5
Monitoring of statins LFTs at 0, 3, 12m
Monitoring of amiodarone TFT, LFTs, U&Es, CXR at 0 TFT, LFTs 6mthly
Monitoring of methotrexate FBC, LFTs, U&Es at 0, weekly until stablised then 3mthly
Monitoring of azathioprine Check TPMT before treatment (predisposes to pancytopenia if deficient) FBC, LFTs at 0 then 3mthly, monitor FBC weekly for first 4 weeks
Monitoring of lithium TFT, U&Es at 0 then 6mnthly, levels weekly until stablised then 3 mnthly
Monitoring of glitazones LFTs at 0 then 'regularly'
Hepatocellular drug-induced liver disease Paracetamol AEDs- valproate, phenytoin MAOi Halothane Anti-TB/amiodarone Methyldopa Statins
Cholestatic drug-induced liver disease Phenothiazines e.g. chlorpromazine, prochlorperazine Antibiotics Steroids Sulphonylureas Fibrates OCP
Cirrhotic drug-induced liver disease Methotrexate, methyldopa, amiodarone
Avoid in renal failure Antibiotics e.g. tetracycline, nitrofurantion NSAIDS Lithium Metformin
Drugs accumulating in RF (reduce dose) Most antibiotics e.g. penicillins, cephalosporins, vancomycin, gentamicin Digoxin, atenolol Methotrexate Sulphonylurea Furosemide Opioids
Drugs safe in RF Antibiotics e.g. erythromycin, rifampicin Diazepam Warfarin
Drugs exhibiting zero-order kinetics Phenytoin, salicyclates, heparin, ethanol
Causes gynaecomastia Spironolactone, cimetidine, digoxin, cannabis, finasteride, GnRHR agonists e.g. goserelin, oestrogens, anabolic steroids
Created by: NorthernSoul



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