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 |