Pharma Flashcards

Question

Drug Induced Pancytopenia:

Answer 1

* Cytotoxics * Antibiotics: trimethoprim, chloramphenicol * Anti-rheumatoid: gold (sodium aurothiomalate), penicillamine * Carbimazole* * Anti-epileptics: carbamazepine * Sulphonylureas: tolbutamide

Answer 2

* Thiazides * Tetracyclines, sulphonamides, ciprofloxacin * Amiodarone * NSAIDs e.g. Piroxicam * Psoralens * Sulphonylureas

Answer 3

Adverse effects nausea & include vomiting, flu-like headaches and symptoms * Nice recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past

Answer 4

* Should be started 1 week before the patien target date to stop * The recommended course of is 12 weeks (but patients should be monitored regularly and treatment only continued if not smoking) * Has been shown in studies to be more effective than bupropion * Nausea is the most common adverse effect. Other include headache, insomnia, abnormal dreams * V arenicline should be used with caution in patients with a history of depression or self-harm. * Contraindicated in pregnancy and breast feeding

Answer 5

* Should be started 1 to 2 weeks before target date. * Small risk of seizures (1: 1,000) * Bupropion should not be prescribed to individuals with epilepsy or other conditions that lower the seizure threshold, such as alcohol or benzodiazepine withdrawal, anorexia nervosa, bulimia, or active brain tumors. It should be avoided in individuals who are also taking MAOIs. When switching from MAOIs to bupropion, it is important to include a washout period of 2 weeks. Also pregnancy and breastfeeding are contraindications.

Answer 6

mixed respiratory alkalosis and metabolic acidosis sweaty, confused patient pulmonary edema suggests severe poisoning and is an indication for hemodialysis

Answer 7

* Serum concentration > 700mg/L * Metabolic acidosis resistant to treatment * Acute renal failure * Pulmonary edema * Seizures * Coma

Answer 8

Management: * Start N-acetyl cysteine immediately * Naloxone if there is hypoxia or respiratory depression

Answer 9

* Prothrombin time > 100 seconds * Creatinine > 300 μmol/l * Grade III or IV encephalopathy

Answer 10

* Chronic alcohol excess * Patients on p450 enzyme inducers (rifampicin, phenytoin, carbamazepine) * anorexia nervosa: ↓ glutathione stores * HI

Answer 11

Actions * ↓ conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter * ↑ the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump Features * Generally unwell, lethargy, nausea & vomiting, confusion, * Arrhythmias (e.g. AV block, bradycardia)

Answer 12

* Classically: Hypokalemia* * Myocardial ischemia * Hypomagnesemia, acidosis (Hypo pH), Hypercalcemia, Hypernatremia * Hypoalbuminemia * Hypothermia * Hypothyroidism * Drugs: amiodarone, quinidine, verapamil, spironolactone (compete for secretion in distal convoluted tubule therefore ↓ excretion)

Answer 13

Management * Digibind * Correct arrhythmias * Monitor K+

Answer 14

* Hemodynamic instability * Life-threatening arrhythmias * Serum potassium >5 mmol/l in acute toxicity * Plasma digoxin level >13nmol/l * Ingestion of more than 10 mg digoxin in adults and 4 mg in children

Answer 15

Presentation * 'Classical' features: BRICK-RED SKIN, smell of bitter almonds * Acute: hypoxia, hypotension, headache, confusion * Chronic: ataxia, peripheral neuropathy, dermatitis Management * Supportive measures: 100% oxygen * Definitive: IV dicobalt edetate

Answer 16

fomepizole. Also ethanol / hemodialysis

Answer 17

Features of toxicity are divided into 3 stages: * Stage 1: symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness * Stage 2: metabolic acidosis with high anion gap and high osmolar gap. Also tachycardia, hypertension * Stage 3: acute renal failure

Answer 18

* Myocardial infarction * Both tachycardia and bradycardia may occur * Hypertension * QRS widening and QT prolongation * Aortic dissection

Answer 19

Neurological effects * Seizures * Hypertonia * Hyperreflexia

Answer 20

Clinical features * Neurological: agitation, anxiety, confusion, ataxia * Cardiovascular: tachycardia, hypertension * Water intoxication * Hyperthermia * Rhabdomyolysis * Hyponatremia

Answer 21

Management * Supportive * Dantrolene may be used for hyperthermia if simple measures fail

Answer 22

* Paraesthesia * Visual field defects * Hearing loss * Irritability * Renal tubular acidosis

Answer 23

2,3-dimercapto-1- propanesulfonic acid (DMPS), D- penicillamine (DPCN), or dimercaprol (BAL). Only DMSA is FDA-approved for use in children for treating mercury poisoning. no clear clinical benefit from DMSA treatment for poisoning due to mercury vapor.

Answer 24

abdominal pain and neurological signs Features * Abdominal pain * Peripheral neuropathy (mainly motor) * Fatigue * Constipation * Blue lines on gum margin (only 20% of adult patients, very rare in children)

Answer 25

Microcytic anemia * Blood film shows red cell abnormalities including basophilic stippling and clover- leaf morphology * Raised serum and urine levels of delta aminolaevulinic acid may be seen making it sometimes difficult to differentiate from acute intermittent porphyria * Urinary coproporphyrin is also ↑ (urinary porphobilinogen and uroporphyrin levels are normal to slightly

Answer 26

Dimercaptosuccinic acid (DMSA) * D-penicillamine * EDT A (EthyleneDiamineTetraAcetic acid) * Dimercapro

Answer 27

Confusion, pyrexia and pink mucosae are typical features of carbon monoxide poisoning Management * 100% oxygen * Hyperbaric oxyge

Answer 28

* Loss of consciousness at any point * Neurological signs other than headache * Myocardial ischemia or arrhythmia * Pregnancy

Answer 29

dystonic reaction to certain drugs or medical conditions Features (extra pyramidal) * Restlessness, agitation * Involuntary upward deviation of the eyes

Answer 30

Phenothiazines * Haloperidol * Metoclopramide * Postencephalitic Parkinson’ s disease.

Answer 31

Treatment * Procyclidine * Benztropine

Answer 32

Tetracyclines * Aminoglycosides * Sulphonamides * Trimethoprim * Quinolones: the BNF advises to avoid due to arthropathy in some animal studies

Answer 33

ACE inhibitors, ARBs * Statins * W arfarin * Sulfonylureas * Retinoids (including topical) * Cytotoxic agents

Answer 34

Antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides * Psychiatric drugs: lithium, benzodiazepines, clozapine * Aspirin * Carbimazole * Sulphonylureas * Cytotoxic drugs * Amiodarone

Answer 35

Antibiotics: penicillins, cephalosporins, trimethoprim * Endocrine: glucocorticoids (avoid high doses), levothyroxine* * Epilepsy: sodium valproate, carbamazepine * Asthma: salbutamol, theophyllines * Psychiatric drugs: tricyclic antidepressants, antipsychotics** * Hypertension: β-blockers, hydralazine, methyldopa * Anticoagulants: warfarin, heparin * Digoxin

Answer 36

Activates antithrombin III forms a complex that inhibits Xa, IXa, XIa and XIIa Activated partial thromboplastin Anti-Factor Xa (although routine time (APTT)

Answer 37

Activates antithrombin III forms a complex that inhibits Xa, monitored with Xa

Answer 38

* Immune mediated - antibodies form which cause the activation of platelets * Usually does not develop until after 5-10 days of treatment * Despite being associated with low platelets HIT is actually a prothrombotic condition * Features include a greater than 50% reduction in platelets, thrombosis and skin allergy * Treatment options include alternative anticoagulants such as lepirudin and danaparoid

Answer 39

phentolamine

Answer 40

Trough levels immediately before dose

Answer 41

Trough levels immediately before dose

Answer 42

Digoxin * At least 6 hrs post-dose

Answer 43

Lithium * Range = 0.4 - 1.0 mmol/l * Take 12 hrs post-dose

Answer 44

* Blepharospasm * Hemifacial spasm * Focal spasticity including cerebral palsy patients, hand and wrist disability associated with stroke * Spasmodic torticollis * Severe hyperhidrosis of the axillae * Achalasia

Answer 45

dverse effects * Teratogenicity: ♀s MUST be using two forms of contraception (e.g. COCP and condoms) * Dry skin, eyes and lips: the most common side-effect of isotretinoin * Low mood, depression * Raised triglycerides * Hair thinning * Nose bleeds (caused by dryness of the nasal mucosa) * Benign intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason

Answer 46

Oral codeine Oral morphine Divide by 10 Oral tramadol Oral morphine Divide by 5 Oral morphine Oral oxycodone Divide by 2 Oral morphine To Subcutaneous diamorphine Divide by 3 Oral oxycodone Subcutaneous diamorphine Divide by 1.5

Answer 47

1mg prednisolone = 4mg hydrocortisone * 1mg dexamethasone = 7mg prednisolone

Answer 48

* Anxiety * Age less than 50 years old * Concurrent use of opioids * The type of chemotherapy used

Answer 49

For patients at low-risk of symptoms then drugs such as metoclopramide may be used first-line. For high-risk patients then 5HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone

Answer 50

α-1 adrenoceptor antagonist used in the treatment of hypertension and benign prostatic hypertrophy

Answer 51

Mechanism of action - not fully understood, two theories: * Interferes with inositol triphosphate formation * Interferes with cAMP formation

Answer 52

Adverse effects * Nausea/vomiting, diarrhea * Fine tremor * Polyuria * Thyroid enlargement, may lead to hypothyroidism * ECG: T wave flattening/inversion * W eight gain

Answer 53

Inadequate monitoring of patients taking lithium is common - NICE and the National Patient Safety Agency (NPSA) have issued guidance to try and address this. As a result it is often an exam hot topic * Lithium blood level should ‘normally’ be checked every 3 months. Levels should be taken 12 hours post-dose * Thyroid and renal function should be checked every 6 months * Patients should be issued with an information booklet, alert card and record book

Answer 54

precipitated by dehydration, renal failure, diuretics (Especially bendroflumethiazide) or ACE inhibitors and ARBs

Answer 55

Features of toxicity * Coarse tremor (a fine tremor is seen in therapeutic levels) * Acute confusion * Seizure * Coma

Answer 56

anagement * Mild-moderate toxicity may respond to volume resuscitation with normal saline * Hemodialysis may be needed in severe toxicity * Sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion.

Answer 57

Features of severe poisoning include: * Arrhythmias * Seizures * Metabolic acidosis * Coma

Answer 58

* Sinus tachycardia * Widening of QRS * Prolongation of QT interval

Answer 59

Chronic * Common: gingival hyperplasia, hirsuitism, coarsening of facial features * Megaloblastic anemia (secondary to altered folate metabolism) * Peripheral neuropathy * Enhanced vitamin D metabolism causing osteomalacia * Lymphadenopathy * Dyskinesia

Answer 60

management epilepsy and is first line therapy for generalised seizures. It works by increasing GABA activity

Answer 61

Adverse effects * Gastrointestinal: nausea * ↑ appetite and weight gain * Alopecia: regrowth may be curly (note that phenytoin → hirsutism while valporate → alopecia) * Ataxia * Tremor * Hepatitis (also with phenytoin) * Pancreatitis * Teratogenic

Answer 62

Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD) * Salivation * Lacrimation * Urination * Defecation * Cardiovascular: hypotension, bradycardia * Also: small pupils, muscle fasciculation

Answer 63

Management * Atropine * The role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit

Answer 64

* Shown to be as effective as tricyclic antidepressants in the treatment of mild-moderate depression * Mechanism: thought to be similar to SSRIS (although noradrenaline uptake inhibition has also been demonstrated) * NICE advise 'may be of benefit in mild or moderate depression, but its use should not be prescribed or advised because of uncertainty about appropriate doses, variation in the nature of preparations, and potential serious interactions with other drugs' Adverse effects * Profile in trials similar to placebo * Can cause serotonin syndrome * Inducer of P450 system, therefore ↓ levels of drugs such as warfarin, Cyclosporin. The effectiveness of the combined oral contraceptive pill may also be ↓

Answer 65

* E.g. tranylcypromine, phenelzine * Used in the treatment of depression and other psychiatric disorder * Not used frequently due to side-effects

Answer 66

Hypertensive crisis: MAOIs reacting with tyramine containing foods e.g. Cheese, pickled herring, Bovril, oxo, marmite, broad beans, liver, wine. * Anticholinergic effects

Answer 67

* Sumatriptan is a 5-HT1D receptor agonist which is used in the acute treatment of migraine * Ergotamine is a partial agonist of 5-HT1 receptors

Answer 68

* Pizotifen is a 5-HT2 receptor antagonist used in the prophylaxis of migraine attacks. * Methysergide is another antagonist of the 5-HT2 receptor but is rarely used due to the risk of retroperitoneal fibrosis * Cyproheptadine is a 5-HT2 receptor antagonist which is used to control diarrhea in patients with carcinoid syndrome * Olanzapine is 5-HT2 antagonist and D2 dopamin receptor blocker, it’s an atypical antipsychotic * Ondansetron and Granisetron are 5-HT3 receptor antagonist and is used as an antiemetic... They cause conistipation, dizziness and headache.

Answer 69

are specific 5-HT1 agonists used in the acute treatment of migraine. They are generally used second line when standard analgesics such as paracetamol and ibuprofen are ineffective

Answer 70

* Should be taken as soon as possible after the onset of headache, rather than at onset of aura * Oral, orodispersible, nasal spray and subcutaneous injections are available Adverse effects * 'Triptan sensations' - tingling, heat, tightness (e.g. Throat and chest), heaviness, pressure Contraindications * Patients with a history of, or significant risk factors for ischemic heart disease or cerebrovascular disease

Answer 71

Indications * Parkinson's disease * Prolactinoma/galactorrhoea * Cyclical breast disease * Acromegaly Adverse effects * Nausea/vomiting * Postural hypotension * Hallucinations * Daytime somnolence

Answer 72

enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). They therefore are used for a variety of purposes: * Sedation * Hypnotic * Anxiolytic * Anticonvulsant * Muscle relaxant

Answer 73

* Switch patients to the equivalent dose of diazepam * Reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5 mg * Time needed for withdrawal can vary from 1 month to 1 year or more

Answer 74

class III antiarrhythmic agent used in the treatment of both atrial and ventricular tachycardias. ain mechanism of action is by blocking potassium channels which inhibits repolarisation and hence prolongs the action potential. Amiodarone also has other actions such as blocking sodium channels (a class I-a effect)

Answer 75

* Long half-life (20-100 days) * Should ideally be given into central veins (causes thrombophlebitis) * Has proarrhythmic effects due to lengthening of the QT interval * Interacts with drugs commonly used concurrently e.g. ↓ metabolism of warfarin = P450 inhibtor * Numerous long-term adverse effects (see below)

Answer 76

TFT, LFT, U&E, CXR prior to treatment. U&E to check hypokalemia * TFT, LFT every 6 months

Answer 77

* Thyroid dysfunction * Corneal deposits * Pulmonary fibrosis/pneumonitis * Liver fibrosis/hepatitis * Peripheral neuropathy, myopathy * Photosensitivity * 'Slate-grey' appearance

Answer 78

The pathophysiology of amiodarone-induced hypothyroidism (AIH) is thought to be due to the high iodine content of amiodarone causing a Wolff-Chaikoff effect (an autoregulatory phenomenon where thyroxine formation is inhibited due to high levels of circulating iodide)

Answer 79

Vaughan Williams class I-c antiarrhythmic. It slows conduction of the action potential by acting as a potent sodium channel blocker. This may be reflected by widening of the QRS complex and prolongation of the PR interval

Answer 80

lecainide was actually shown to ↑ mortality post myocardial infarction and is therefore contraindicated in this situation.

Answer 81

Indications * Atrial fibrillation * SVT associated with accessory pathway e.g. Wolf-Parkinson-White syndrome Adverse effects * Negatively inotropic * Bradycardia * Proarrhythmic * Oral paraesthesia * Visual disturbance

Answer 82

inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis → Statins: ↓ cholesterol synthesis.

Answer 83

Myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase. Risks factors for myopathy include advanced age, ♀, low BMI and presence of multisystem disease such as diabetes mellitus. Myopathy is more common in lipophilic statins (simvastatin, atorvastatin) than relatively hydrophilic statins (rosuvastatin, pravastatin, fluvastatin) * Liver impairment: 2008 NICE guidelines recommend checking LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

Answer 84

Myositis, pruritus, cholestasis

Answer 85

reatment of patients with hyperlipidemia, although its use is limited by side-effects. As well as lowering cholesterol and triglyceride concentrations it also raises HDL levels Adverse effects * Flushing * Impaired glucose tolerance Myositis

Answer 86

: atropine + glucagon Glucagon has a positive inotropic action on the heart and ↓ renal vascular resistance. It is therefore useful in patients with β-blocker cardiotoxicity Hemodialysis is not effective in β-blocker overdose

Answer 87

Bradycardia * Hypotension * Heart failure * Syncope

Answer 88

inhibiting chloride absorption in the ascending loop of Henle. The name of Lasix is derived from lasts six (hours) referring to its duration of action.

Answer 89

Adverse effects * Hyponatremia * Hypokalemia * Hypocalcaemia * Hypochloraemic alkalosis (Hyper pH) * Ototoxicity * Renal impairment (from dehydration + direct toxic effect) * Hyperglycaemia (less common than thiazides) * Gout

Answer 90

thiazide diuretic which works by inhibiting sodium absorption at the beginning of the distal convoluted tubule (DCT) mechanism of Hypokalemia: * ↑ sodium reaching the collecting ducts * Activation of the renin-angiotensin-aldosterone

Answer 91

* Dehydration * Postural hypotension * Hyponatremia, Hypokalemia, Hypercalcemia * Gout * Impaired glucose tolerance, Hyperglycaemia * Impotence

Answer 92

aldosterone antagonist which acts act in the distal convoluted tubule

Answer 93

* Hyperkalemia * Gynaecomastia

Answer 94

Adenosine * Dipyridamole enhances effect * Aminophylline ↓ effect Causes transient heart block in the AV node * Agonist of the A1 receptor which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux * Adenosine has a very short half-life of about 8-10 seconds

Answer 95

Chest pain * Bronchospasm * Can enhance conduction down accessory pathways, resulting in ↑ ventricular rate (e.g. WPW)

Answer 96

side-effects: headache, flushing, ankle edema

Answer 97

Effects peripheral circulation i.e. Used for hypertension, raynaud's * May bring on angina due to sympathetic reflex following vasodilation * Side-effects: headache, flushing, ankle edema

Answer 98

* Contraindications: heart failure, heart block, on β-blockers * Side-effects: headache, constipation, heart block

Answer 99

works by blocking the action of both cyclooxygenase-1 and 2. Hypotension, bradycardia, heart failure, ankle swelling Ca Channel Blocker Indications & Notes SE / CI Verapamil Angina, hypertension, arrhythmias Highly negatively inotropic Should not be given with beta-blockers as may cause heart block Heart constipation, hypotension, bradycardia failure, Diltiazem Nifedipine, amlodipine, felodipine (dihydropyridines) Hypertension, angina, Raynaud's Flushing, headache, ankle swelling Affects the peripheral vascular smooth muscle more than the myocardium and therefore do result in worsening of heart failure (but not amlodepine) Cyclooxygenase is responsible for prostaglandin, prostacyclin and thromboxane synthesis. The blocking of thromboxane A2 formation in platelets reduces the ability of platelets to aggregate which has lead to the widespread use of low-dose aspirin in cardiovascular disease. All patients with established cardiovascular disease should take aspirin if there is no contraindication.

Answer 100

All people with established cardiovascular disease (stroke, TIA, IHD, peripheral arterial disease) * All people aged 50 years and over with a 10-year cardiovascular risk = 20% * All people with diabetes mellitus (type 1 or 2) who are = 50 years old or who have: diabetes > 10 years, taking treatment for hypertension or evidence of target organ damage * All people with target organ damage from hypertension

Answer 101

All people with established cardiovascular disease (stroke, TIA, IHD, peripheral arterial disease) * All people aged 50 years and over with a 10-year cardiovascular risk = 20% * All people with diabetes mellitus (type 1 or 2) who are = 50 years old or who have: diabetes > 10 years, taking treatment for hypertension or evidence of target organ damage * All people with target organ damage from hypertension

Answer 102

Mechanism of action: * Inhibit the conversion angiotensin I to angiotensin II

Answer 103

Side-effects: * Cough: occurs in around 15% of patients and may occur up to a year after starting treatment. Thought to be due to increased bradykinin levels * Angioedema: may occur up to a year after starting treatment * Hyperkalaemia st * 1 -dose hypotension: more common in patients taking diuretics

Answer 104

Pregnancy and breastfeeding - avoid * Renovascular disease - significant renal impairment may occur in patients who have undiagnosed bilateral renal artery stenosis * Aortic stenosis - may result in hypotension * Patients receiving high-dose diuretic therapy (more than 80 mg of furosemide a day) - signficantly increases the risk of hypotension * Hereditary of idiopathic angioedema

Answer 105

Urea and electrolytes should be checked before treatment is initiated and after increasing dose * A rise in the creatinine and potassium may be expected after starting ACE inhibitors. Acceptable increases are an increase in serum creatinine, up to 50% from baseline or up to 265 μmol/l (whichever is smaller) and an increase in potassium up to 5.5 mmol/l.

Answer 106

Colchium alkaloids *colchicine NSAIDS *indoethacine *Naproxen *Phenylbutazone *Ibuprofen

Answer 107

Uricosuric *probenecid *sulfinpyazone Xanthine Oxidase Inhibitor *allopurinol

Answer 108

is used in the prevention of gout. It works by inhibiting xanthine oxidase which is responsible for the oxidation of 6-mercaptopurine to 6-thiouric acid

Answer 109

* Allopurinol should not be started until 2 weeks after an acute attack has settled * Initial dose of 100 mg od, with the dose titrated every few weeks to aim for a serum uric acid of < 300 μmol/l * NSAID or colchicine cover should be used when starting allopurinol

Answer 110

Recurrent attacks - the British Society for Rheumatology recommend 'In uncomplicated gout uric acid lowering drug therapy should be started if a second attack, or further attacks occur within 1 year' * Tophi * Renal disease * Uric acid renal stones * Prophylaxis if on cytotoxics or diuretics * Patients with Lesch-Nyhan syndrome often take allopurinol for life

Answer 111

* Metabolised to active compound 6-mercaptopurine * Xanthine oxidase is responsible for the oxidation of 6-mercaptopurine to 6-thiouric acid * Allopurinol can therefore lead to high levels of 6-mercaptopurine * A much ↓ dose (e.g. 25%) must therefore be used if the combination cannot be avoided

Answer 112

Allopurinol ↓ renal clearance, therefore may cause marrow toxicity

Answer 113

Indications * Vasomotor symptoms such as flushing, insomnia and headaches * Premature menopause: should be continued until the age of 50 years * Osteoporosis: but should only be used as second-line treatment

Answer 114

Side-effects * Nausea * Breast tenderness * Fluid retention and weight gain

Answer 115

Side-effects * Nausea * Breast tenderness * Fluid retention and weight gain

Answer 116

↑ Risk of breast cancer: ↑ by the addition of a progestogen * ↑ Risk of venous thromboembolism: ↑ by the addition of a progestogen * ↓ Risk of endometrial cancer: ↓ by the addition of a progestogen but not eliminated completely. The BNF states that the additional risk is eliminated if a progestogen is given continuously

Answer 117

↑ Risk of breast cancer ↑ Risk of DVT ↓ Risk of endometrial ca.

Answer 118

Examples of UKMEC 3 conditions include * More than 35 years old and smoking less than 15 cigarettes/day * BMI 35-39 kg/m2 * Migraine without aura and more than 35 years old * Family history of thromboembolic disease in first degree relatives < 45 years * Controlled hypertension * Breast feeding 6 weeks - 6 months postpartum

Answer 119

* More than 35 years old and smoking more than 15 cigarettes/day * BMI > 40 kg/ m2 * Migraine with aura * History of thromboembolic disease or thombogenic mutation * History of stroke or ischemic heart disease * Uncontrolled hypertension * Breast cancer * Major surgery with prolonged immobilisation

Answer 120

is a selective estrogen receptor modulator (SERM) which acts as an estrogen receptor antagonist and partial agonist. It is used in the management of estrogen receptor positive breast cancer

Answer 121

Adverse effects * Hot flushes * Menstrual disturbance: vaginal bleeding, amenorrhoea * V enous thromboembolism * Endometrial cancer * Alopecia * Cataracts

Answer 122

is a pure estrogen receptor antagonist, and carries a lower risk of endometrial cancer

Answer 123

is an oral anticoagulant which inhibits the reduction of vitamin K to its active hydroquinone form, which in turn acts as a cofactor in the formation of clotting factor II, VII, IX and X (mnemonic = 1972) and protein C

Answer 124

chheck INR 72 hours before procedure, proceed if INR < 4.0

Answer 125

* Liver disease * P450 enzyme inhibitors, e.g.: amiodarone, ciprofloxacin * Cranberry juice * Drugs which displace warfarin from plasma albumin, e.g. NSAIDs * Inhibit platelet function: NSAIDs

Answer 126

Hemorrhage * Teratogenic * Skin necrosis: when warfarin is first started biosynthesis of protein C is ↓. This results in a temporary procoagulant state after initially starting warfarin, normally avoided by concurrent heparin administration. Thrombosis may occur in venules leading to skin necrosis

Answer 127

Stop warfarin Vitamin K 5mg IV Prothrombin complex concentrate - if not available then FFP*

Answer 128

Stop warfarin, restart when INR < 5.0 If risk factors for bleeding then give vitamin K 0.5mg IV or 5mg PO. Risk factors include: * Age > 70 years * First year of warfarin therapy * History of gastrointestinal bleeding * Hypertension * Alcohol excess Dose can be repeated after 24 hours if INR still high

Answer 129

Stop warfarin, restart when INR < 5.0

Answer 130

Acyclovir is phosphorylated by thymidine kinase which in turn inhibits the viral DNA polymerase

Answer 131

* Effective against a range of DNA and RNA viruses * Interferes with the capping of viral mRNA

Answer 132

Inhibit synthesis of mRNA, translation of viral proteins, viral assembly and release

Answer 133

* Used to treat influenza * Inhibits uncoating of virus in cell

Answer 134

Examples: zidovudine (AZT), didanosine, lamivudine, stavudine, zalcitabine

Answer 135

Inhibits a protease needed to make virus able to survive outside the cell * Examples: indinavir, nelfinavir, ritonavir, saquinavir

Answer 136

(NNRTI) examples: nevirapine, efavirenz

Answer 137

* nevirapine (NNRTI): induces P450 * protease inhibitors: inhibits P450

Answer 138

peripheral neuropathy * Zidovudine: anemia, myopathy, black nails * Didanosine: pancreatitis

Answer 139

Examples: indinavir, nelfinavir, ritonavir, saquinavir * Side-effects: diabetes, hyperlipidemia, buffalo hump, central obesity, p450 enzyme inhibition * Indinavir: renal stones, asymptomatic hyperbilirubinemia * Ritonavir: a potent inhibitor of the p450 system HIV: anti-retrovirals - P450 interaction * nevirapine (NNRTI): induces P450 * protease inhibitors: inhibits P450

Answer 140

immunosuppressant which ↓ clonal proliferation of T cells by reducing IL-2 release. It acts by binding to cyclophilin forming a complex which inhibits calcineurin, a phosphotase that activates various transcription factors in T cells

Answer 141

inhibit calcineurin thus decreasing IL-2

Answer 142

* Nephrotoxicity * Hepatotoxicity * Fluid retention * Tremor * Hypertension * Hyperkalemia * Hypertrichosis * Hyperplasia of gum * Impaired glucose tolerance, hyperglycemia.

Answer 143

Tacrolimus is a macrolide antibiotic and is used as an immunosuppressant to prevent transplant rejection. It has a very similar action to Cyclosporin; the action of tacrolimus differs in that it binds to a protein called FKBP rather than cyclophilin Tacrolimus is more potent than Cyclosporin and hence the incidence of organ rejection is less. However, nephrotoxicity and impaired glucose tolerance is more common

Answer 144

metabolised to the active compound mercaptopurine, purine synthesis inhibitor, inhibiting the proliferation of cells, especially leukocytes/lymphocytes. autoimmune diseases, or in combination with other immunosuppressants in organ transplantation. Caution should be exercised when it is used in conjunction with purine analogues such as allopurinol, you may give only 25% of the usual dose of azathioprine. Thiopurine methyltransferase (TPMT) deficiency is present in about 1 in 200 people and predisposes to azathioprine related pancytopaenia. A thiopurine methyltransferase (TPMT) test may be needed to look for individuals prone to azathioprine toxicity

Answer 145

* Bone marrow depression * Nausea/vomiting * Pancreatitis

Answer 146

antimetabolite which inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines

Answer 147

Adverse effects * Mucositis * Myelosuppression * Pneumonitis * Liver cirrhosis

Answer 148

* Methotrexate is a drug with a high potential for patient harm. It is therefore important that you are familiar with guidelines relating to its use * Methotrexate is taken weekly, rather than daily * FBC, U&E and LFTs need to be regularly monitored. The Committee on Safety of Medicines recommend 'FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months' * Folic acid 5mg once weekly should be coprescribed, taken more than 24 hours after methotrexate dose * The starting dose of methotrexate is 7.5 mg weekly * Only one strength of methotrexate tablet should be prescribed (usually 2.5 mg) * Avoid prescribing trimethoprim or cotrimoxazole concurrently - increases risk of marrow aplasia

Answer 149

nhibits inosine monophosphate dehydrogenase

Answer 150

antimetabolite which inhibits dihydrofolate reductase

Answer 151

Side effects: * Flu-like illness * ↓BP during fever * Tumor side pain

Answer 152

an inhibitor of 5-α-reductase, an enzyme which metabolises testosterone into dihydrotestosterone. Its indications are: * Benign prostatic hyperplasia * ♂-pattern baldness

Answer 153

Adverse effects: * Impotence * ↓ libid * Ejaculation disorders * Gynaecomastia and breast tenderness Finasteride causes ↓ levels of serum prostate specific antigen

Answer 154

analogues of pyrophosphate, a molecule which ↓ demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis

Answer 155

Adverse effects * Esophageal reactions: oesophagitis, esophageal ulcers (especially alendronate) * Osteonecrosis of the jaw * MHRA has warned about an increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

Answer 156

a phosphodiesterase type V inhibitor used in the treatment of impotence

Answer 157

nitrates and nicorandil Nicorandil has a nitrate component as well as being a potassium channel activator The BNF recommends avoiding α-blockers for 4 hours after sildenafil

Answer 158

Contraindications * Patients taking nitrates and related drugs such as nicorandil * Hypotension * Recent stroke or myocardial infarction * Non-arteritic anterior ischemic optic neuropathy

Answer 159

* Visual disturbances e.g. Blue discoloration, non-arteritic anterior ischemic neuropathy * Nasal congestion * Flushing * Gastrointestinal side-effects

Answer 160

Overview * Long-acting analogue of somatostatin * Somatostatin is release from D cells of pancreas and inhibits the release of growth hormone Uses * Acute treatment of variceal hemorrhage * Acromegaly * Carcinoid syndrome * Prevent complications following pancreatic surgery * VIPomas

Answer 161

Adverse effects * Gallstones (secondary to biliary stasis)

Answer 162

The main use of theophyllines in clinical medicine is as a bronchodilator in the management of asthma and COPD The exact mechanism of action has yet to be discovered. One theory suggests theophyllines may be a non-specific inhibitor of phosphodiesterase resulting in ↑ cAMP. Other proposed mechanisms include antagonism of adenosine and prostaglandin inhibition

Answer 163

Acidosis, Hypokalemia * V omiting * Tachycardia, arrhythmias * Seizures

Answer 164

Activated charcoal * Charcoal hemoperfusion is preferable to hemodialysis

Answer 165

* Chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors * Alcohol withdrawal is thought to lead to the opposite (↓ inhibitory GABA and ↑ NMDA glutamate transmission)

Answer 166

Features * Symptoms start at 6-12 hours * Peak incidence of seizures at 36 hours * Peak incidence of delirium tremens is at 72 hours Management * Benzodiazepines * Carbamazepine also effective in treatment of alcohol withdrawal * Phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures

Answer 167

group of drugs which profoundly ↓ acid secretion in the stomach. They irreversibly block the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase) of the gastric parietal cell. Examples include omeprazole and lansoprazole.

Answer 168

5-aminosalicyclic acid (5-ASA) is released in the colon and is not absorbed. It acts locally as an anti-inflammatory. The mechanism of action is not fully understood but 5-ASA may inhibit prostaglandin synthesis

Answer 169

A combination of sulphapyridine (a sulphonamide) and 5-ASA * Many side-effects are due to the sulphapyridine moiety: rashes, oligospermia, headache, Heinz body anemia * Other side-effects are common to 5-ASA drugs (see mesalazine)

Answer 170

* A delayed release form of 5-ASA * Sulphapyridine side-effects seen in patients taking sulphasalazine are avoided * Mesalazine is still however associated with side-effects such as GI upset, diarrhea, headache, agranulocytosis, pancreatitis*, interstitial nephritis

Answer 171

* Primary and secondary immunodeficiency * Idiopathic thrombocytopenic purpura (ITP) * Myasthenia gravis * Guillain-Barre syndrome * Kawasaki disease * Toxic epidermal necrolysis (TEN) * Pneumonitis induced by CMV following transplantation * Low serum IgG levels following hematopoietic stem cell transplant for malignancy * Dermatomyositis * Chronic inflammatory demyelinating polyradiculopathy

Answer 172

*Penicillins * Cephalosporins * Isoniazid * V ancomycin

Answer 173

*aminoglycosides (cause misreading of mRNA) * chloramphenicol *macrolides (e.g. erythromycin) * tetracyclines *fusidic acid * (Quin/Dalfo)pristin * Linezolid

Answer 174

*quinolones (e.g. ciprofloxacin) * metronidazole * sulphonamides * trimethoprim

Answer 175

rifampicin

Answer 176

* Penicillins * Cephalosporins * Isoniazid * Aminoglycosides * Quinupristin+Dalfopristin (combination) * Metronidazole * Quinolones: ciprofloxacin, levofluxacin * Rifampicin * Nitrofurantoin → Damages bacterial DNA

Answer 177

* Chloramphenicol * Macrolides * Tetracyclines * Fusidic acid * Quinupristin * Dalfopristin * Linezolid * Sulphonamides * Trimethoprim

Answer 178

1st macrolide used clinically. Newer examples include clarithromycin and azithromycin. Erythromycin may potentially interact with amiodarone, warfarin and simvastatin Macrolides act by inhibiting bacterial protein synthesis. If pushed to give an answer they are bacteriostatic in nature, but in reality this depends on the dose and type of organism being treated.

Answer 179

it has prokinetic properties, Promotes gastric emptying

Answer 180

* GI side-effects are common * Cholestatic jaundice: risk may be ↓ if erythromycin stearate is used * P450 inhibitor

Answer 181

group of antibiotics which work by inhibiting DNA synthesis and are bactericidal in nature. Examples include: * Ciprofloxacin * Levofloxacin

Answer 182

* Lower seizure threshold in patients with epilepsy * Tendon damage (including rupture) - the risk is ↑ in patients also taking steroids. Achilles tendon ruptures. Tendon damage is a well documented complication of quinolone therapy. It appears to be an idiosyncratic reaction, with the actual median duration of treatment being 8 days before problems occur

Answer 183

Overview * Injectable streptogrammin antibiotic * Combination of group A and group B streptogrammin * Inhibits bacterial protein synthesis by blocking tRNA complexes binding to the ribosome Spectrum * Most Gram positive bacteria * Exception: Enterococcus faecalis

Answer 184

Adverse effects * Thrombophlebitis (give via a central line) * Arthralgia * P450 inhibitor

Answer 185

type of oxazolidonone antibiotic which has been introduced in recent years. It inhibits bacterial protein synthesis by stopping formation of the 70s initiation complex and is bacteriostatic nature

Answer 186

Adverse effects * Thrombocytopenia (reversible on stopping) * Monoamine oxidase inhibitor: avoid tyramine containing foods

Answer 187

Antibacterial sulfonamides act as competitive inhibitors of the enzyme dihydropteroate synthetase (DHPS), an enzyme involved in folate synthesis.

Answer 188

: sulfonamide antibiotic combination of trimethoprim and sulfamethoxazole, in the ratio of 1 to 5, used in the treatment of a variety of bacterial infections.

Pharma Flashcards

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