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Pharmacology- NS
| Question | Answer |
|---|---|
| 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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