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