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PSA Flashcards

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1
Q

What drug may be given in an anaphylactoid reaction?

A

Chlorphenamine

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2
Q

MOA of chlorphenamine

A

Antihistamine

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3
Q

What drug may be given in an anaphylactoid reaction with significant bronchospasm?

A

Salbutamol

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4
Q

How would a patient with repeated anaphylactoid reactions to acetylcysteine be managed?

A

Prophylactic antihistamines (chlorphenamine and ranitidine)

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5
Q

First line drug for anaphylaxis, with dose and administration

A

Adrenaline 0.5mL 1 in 1000 IM

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6
Q

Anti-hypertensives in pregancy

A

Labetalol, Methyldopa, Nifedipine

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7
Q

Advice to women on antihypertensive who are planning pregnancy

A

Risk of congenital malformations so consider switching to a safer drug

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8
Q

Drugs that cause hyperkalaemia

A

ACEi
ARB
Spironolactone / Eplerenone / Amiloride
Co-amilofruse

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9
Q

Drugs that cause hypokalaemia

A

Bendroflumethiazide / Indapamide

Furosemide

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10
Q

What vitamin should be prescribed in pregnancy (and dose)

A

Folic acid 5mg PO OD

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11
Q

Vitamin C name

A

Ascorbic acid

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12
Q

Vitamin K drug name

A

Menadiol

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13
Q

Advice for patients taking long term steroids

A

Don’t stop suddenly

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14
Q

Drugs that cause hyponatraemia

A 
PPIs
SSRIs
ACEi
Diuretics
Carbamazepine
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15
Q

Tests before starting amiodarone

A

CXR, U&Es, TFTs

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16
Q

Concerning ADR of statins

A

Rhabdomyolysis

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17
Q

Tests before adalimumab

A

CXR, CRP, FBC

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18
Q

ADRs of thiazides

A 
Common adverse effects:
dehydration
postural hypotension
hyponatraemia, hypokalaemia, hypercalcaemia*
gout
impaired glucose tolerance
impotence

Rare adverse effects:
thrombocytopaenia
agranulocytosis
photosensitivity rash
pancreatitis
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19
Q

Indication for mycophenolate mofetil

A

Prevention of transplant rejection

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20
Q

MOA of dipyrimadole

A

Anti-platelet

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21
Q

MOA of ticagrelor

A

Anti-platelet

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22
Q

MOA of prasugrel

A

Anti-platelet

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23
Q

What drug is used in scabies?

A

Permethrin

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24
Q

MOA of metoclopramide

A

Dopamine receptor antagonist (anti-emetic)

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25
Contraindication of metoclopramide
Parkinson's | Children
26
Indications for metoclopramide
Nausea GORD Gastroparesis secondary to diabetic neuropathy / migraine
27
ADRs of metoclopramide
Parkinsonism / tardive dyskinesia | Prolonged QT
28
ADRs of digoxin
GI upset Arrhythmias Yellow vision Gynaecomastia
29
MOA of cetuximab
Monoclonal antibody against epidermal growth factor receptor
30
Indications of cetuximab
Metastatic colorectal or head and neck cancer
31
MOA of infliximab
Anti-TNF antibody
32
Indications for infliximab
RA and Crohns
33
MOA of rituximab
Anti-CD20 antibody
34
Indications for rituximab
RA and non-Hodgkin lymphoma
35
MOA of trastuzumab
HER2 receptor antagonist
36
Indications for trastuzumab
HER2 positive breast cancer
37
ADRs of beta-2 agonists
Angioedema, arrhythmias, tremor, rash, hypokalaemia
38
Contraindications for beta-2 agonists
Cardiovascular disease, arrhythmias, hypokalaemia
39
ADRs of muscarinic antagonists
Constipation, cough, dry mouth, GI disturbance, headache
40
Contraindications of muscarinic antagonists
Arrhythmias, heart failure, recent MI
41
MOA of ondansetron
Serotonin receptor antagonist (anti-emetic)
42
Indication for ondansetron
Nausea
43
MOA of mycophenolate
Immunosuppressant
44
Indications for mycophenolate
``` Prevention of transplant rejection Inflammatory arthritis (off label) ```
45
Drug that reduces desire to drink
Naltrexone
46
ADRs of PPIs
Short term: Diarrhoea, Nausea | Long term: increased risk of pneumonia and hip fractures
47
ADRs of histamine antagonists
Headache, Diarrhoea, Dizziness, Tolerance
48
Indication for cabergoline
Prolactinoma
49
Indication for tolvaptan
SIADH
50
Contraindication of carbimazole
First trimester of pregnancy
51
How often is methotrexate taken?
Weekly
52
What should be co-prescribed with methotrexate?
Folic acid 5mg once per week (taken on a different day to the methotrexate)
53
Indications for methotrexate
Inflammatory arthritis Crohn's disease Come leukaemia chemotherapy
54
ADRs of methotrexate
``` mucositis myelosuppression pneumonitis pulmonary fibrosis liver fibrosis ```
55
Pregnancy advice with methotrexate
women should avoid pregnancy for at least 6 months after treatment has stopped the BNF also advises that men using methotrexate need to use effective contraception for at least 6 months after treatment
56
Methotrexate monitoring
FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months
57
Methotrexate interactions
Trimethoprim | Aspirin
58
Treatment of methotrexate toxicity
Folinic acid
59
ADRs of dapagliflozin
urinary and genital infection (secondary to glycosuria) normoglycaemic ketoacidosis increased risk of lower-limb amputation: feet should be closely monitored
60
MOA of syntocinon
Synthetic oxytocin
61
Use of ergometrine
Can be used as alternative to oxytocin in the third stage of labour
62
Drugs used in medical termination of pregnancy
Mifepristone and misoprostol
63
Contraindication of pethidine
Renal failure
64
First line in neuropathic pain
Amitriptyline OR pregabalin
65
Second line in neuropathic pain
Amitriptyline AND pregabalin
66
First line in diabetic neuropathic pain
Duloxetine
67
Metformin ADRs
gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20% reduced vitamin B12 absorption - rarely a clinical problem lactic acidosis with severe liver disease or renal failure
68
Metformin contraindications
chronic kidney disease: review if eGFR <45 and stop if eGFR < 30 Recent MI / sepsis / stroke / AKI iodine-containing x-ray contrast media (day of and two days after procedure due to risk of renal impairment alcohol abuse is a relative contraindication
69
How to start metformin
metformin should be titrated up slowly to reduce the incidence of gastrointestinal side-effects
70
How does sotalol work
Blocks K+ channels
71
Route of administration of heparin and LMWH
Heparin: IV LMWH: SC
72
Duration of action of heparin and LMWH
Heparin: Short LMWH: Long
73
Reversal agent for heparin
Protamine sulphate
74
ADRs of heparin
Bleeding Heparin-induced thrombocytopaenia (HIT) Osteoporosis (lower risk with LMWH)
75
Three drugs given acutely in anaphylaxis
Adrenaline, hydrocortisone, cholrphenamine
76
Adrenaline dose in anaphylaxis in adults
500 micrograms (0.5ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
77
Adrenaline dose in anaphylaxis in children 6-12
300 micrograms (0.3ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
78
Adrenaline dose in anaphylaxis in children under 6
150 micrograms (0.15ml 1 in 1,000) IM. Repeat every 5 minutes if necessary
79
Indication for letrozole
Breast cancer in post-menopausal women
80
MOA of letrozole
Aromatase inhibitor
81
ADRs of letrozole
Osteoporosis Flushing Night sweats
82
Indication for tamoxifen
Breast cancer in pre-menopausal women
83
MOA of tamoxifen
Oestrogen receptor blocker
84
First line in Wilson's disease
Penicillamine
85
ADRs of pioglitazone
weight gain liver impairment (monitor LFTs) fluid retention (therefore contraindicated in heart failure) increased risk of fractures and bladder cancer
86
Common ADRs of beta blockers
bradycardia dizziness syncope
87
Common ADRs of digoxin
arrhythmias diarrhoea skin reactions
88
Common ADRs of ACE inhibitors
cough angioedema hyperkalaemia
89
Common ADRs of furosemide
dizziness electrolyte imbalance muscle spasms
90
Common ADRs of spironolactone
electrolyte imbalance malaise skin reactions
91
Cautions of ACE inhibitors
pregnancy and breastfeeding - avoid renovascular disease - may result in renal impairment aortic stenosis - may result in hypotension hereditary of idiopathic angioedema potassium >= 5.0 mmol/L - seek specialist advice
92
Monitoring of ACE inhibitors
urea and electrolytes should be checked before treatment is initiated and after increasing the dose (a rise in the creatinine and potassium may be expected after starting ACE inhibitors acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l)
93
How to start allopurinol
Start 2 weeks after attack of gout has settled Start on a low dose and titrate up every few weeks Consider colchicine cover
94
ADRs of allopurinol
The most significant adverse effects are dermatological and patients should be warned to stop allopurinol immediately if they develop a rash
95
Allopurinol interactions
Azathioprine Cyclophosphamide Theophylline
96
First line in severe malaria
Artesunate
97
Follow-up therapy in severe malaria
Riamet
98
First line in non-severe plasmodium malaria
Riamet or malarone
99
Main treatment for non falciparum malaria
Quinines
100
Indication for rasburicase
Tumour lysis syndrome
101
Indication for colchicine
Gout / pseudogout
102
Treatment for pseudogout
``` Joint injection (corticosteroid and lidocaine) useful if symptoms limited to ≤2 joints. Medications (NSAIDS / colchicine) useful if multiple joints affected or joint injection not possible. Corticosteroids second line Recurrent episodes (≥3 annually) may require prolonged treatment with colchicine ```
103
Drugs to avoid in G6PD deficiency
- Quinines (for malaria) - Nitrofurantoin (an abx) - Quinolones (abx) - Chloramphenicol (abx) - Sulfonamides (abx)
104
Indications for mycophenolate mofetil
Organ transplants | Autoimmune conditions
105
What drug may be used to close a patent ductus arteriosus
Ibuprofen (reduces prostaglandin)
106
Symptoms of Meniere's disease
vertigo, tinnitus, hearing loss and aural fullness
107
Indication for tolvaptan
PCKD
108
MOA of tolvaptan
ADH antagonist
109
What is Augmentin?
Brand name for co-amoxiclav (amoxicillin and clavulanic acid)
110
MOA of leflunomide
DMARD
111
What is co-trimoxazole?
sulfamethoxazole and trimethoprim
112
Common side effect of amlodipine
Ankle swelling
113
Drug to treat HSV / VZV
Aciclovir
114
Drug to treat Hep C / RSV
Ribavirin
115
Drug to treat influenza
Oseltamivir
116
Screening for osteoporosis in steroid use (who should be screened and how?)
Screen people under 40 on high-dose steroids or under 50 on lower or frequent steroid DEXA scan
117
First line antibiotic in a pregnant woman with a UTI
Nitrofurantoin
118
Tests needed before starting amiodarone
CXR, U&Es, TFTs, LFTs
119
Monitoring amiodarone
LFTs and TFTs every 6 months
120
Gentamicin ADRs
Ototoxicity | Nephrotoxicity
121
Monitoring gentamicin
Peak and trough levels
122
MOA of ranolazine
Inhibits late inward sodium channels, which reduces calcium overload in cardiomyocytes
123
Indication for ranolazine
Second line in angina
124
Drug used in benzodiazepine overdose
Flumazenil
125
Drug used in amphetamine or cocaine overdose
Benzodiazepines
126
Drug used to manage opioid overdose
naloxone
127
MOA of naloxone
Opioid antagonist
128
Indication for disulfiram
Chronic alcohol use
129
What does disulfiram do?
Produces unpleasant effects when alcohol is consumed (decreasing desire to drink)
130
Reversal of warfarin
Vitamin K, prothrombin complex concentrate
131
Management of lithium overdose
Volume resuscitation | Dialysis if severe
132
Management of digoxin toxicity
Digoxin-specific antibody fragments
133
Second line meds in tonic clonic epilepsy
Levetiracetam, Clobazam and Topiramate
134
First line in focal epilepsy
Carbamazepine
135
Monitoring when starting clozapine
FBC weekly for 18 weeks (risk of agranulocytosis)
136
Drugs that can be used in hypercalcaemia
Bisphosphonates | Calcitonin
137
Length of action of bisphosphonates
Long term (weeks)
138
ADRs of baclofen
GI side-effects (constipation/diarrhoea), confusion, low mood, dry mouth, headache, paraesthesia or rarely bradyarrhythmias and hypothermia
139
Indication for baclofen
spasticity
140
Medication to consider stopping in gout
Thiazides
141
ADRs of sodium valproate
drug-induced liver injury, pancreatitis, agranulocytosis, severe cutaneous reactions, confusion, abnormal behaviour and increased suicide risk
142
Administration method of aminophylline
Loading dose followed by slow IV injection
143
Tests before starting biologics
Bloods and CXR to check it's safe e.g. check there's no latent TB
144
MOA of celecoxib
NSAID
145
Indication for densosomab
Osteoporosis, prevention of pathological fractures in patients with bony mets
146
Method of administration of densusomab
SC injection | Either every 6 months (for osteoporosis) or every 4 weeks (for bony mets)
147
First line in osteoporosis
Bisphosphonates e.g. alendronate
148
Side effects of bisphosphonates
GI disturbance Oesophagitis Headache Osteonecrosis of the jaw
149
Patient advice for taking bisphosphonates
All patients should be advised to swallow tablets whole with plenty of water while sitting or standing, which should be done on an empty stomach at least 30 minutes before breakfast. They should then remain stood or sat upright for 30 minutes post dose.
150
First line in myasthenia gravis
Acetylcholinesterase inhibitors e.g. pyridostigmine
151
Meds that can precipitate worsening myasthenia gravis
Abx Cardiac meds Neuromuscular meds Steroids
152
What drug is usually given with levodopa and why?
dopa decarboxylase inhibitor to prevent break down of levodopa
153
Alternative to levodopa in younger adults with parkinsons
Dopamine agonists
154
ADRs of older dopamine agonists
Fibrotic disease e.g. lung / kidney fibrosis
155
MOA of tamsulosin
alpha blocker
156
ADRs of tamsulosin
Postural hypotension | Ejaculatory dysfunction
157
MOA of finasteride
5-alpha reductase inhibitor (reduces DHEA, an androgen)
158
Indications for finasteride
BPH
159
ADRs of finasteride
Can result in reduced libido, erectile dysfunction and less commonly ejaculatory dysfunction
160
How long does finasteride take to work?
Up to 6 months
161
Length of treatment in a UTI
3 days in females | 7 days in pregnancy, catheterised patients or males
162
Trade name of viagra
sildenafil
163
First line in erectile dysfunction
sidenafil
164
Contraindications for sildenafil
patients taking nitrates and related drugs such as nicorandil hypotension recent stroke or myocardial infarction (previous 6 months)
165
ADRs of sildenafil
``` visual disturbances nasal congestion flushing gastrointestinal side-effects headache ```
166
Drugs associated with agranulocytosis
antiepileptics e.g.g carbamazepine antithyroid drugs e.g. carbimazole antibiotics e.g. penicillin, chloramphenicol antipsychotics e.g. clozapine
167
Drugs associated with anaemia
causing bleeding e.g. NSAIDs myelosuppression e.g. cytotoxic drugs inducing haemolysis e.g. methyldopa, high-dose penicillin
168
Monitoring of lithium
Serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter.
169
Indication for lithium
Mood stabiliser
170
Symptoms of lithium toxicity
``` coarse tremor (a fine tremor is seen in therapeutic levels) hyperreflexia acute confusion polyuria seizure coma ```
171
MOA of pyridostigmine
Acetylcholinesterase inhibitor
172
ADRs of pyridostigmine
cholinergic side-effects including excess secretions, diarrhoea, GI upset, bronchospasm, sweating and urinary incontinence.
173
Indication for memantine
Moderate to severe alzheimers
174
Contraindication of statins
Acute liver failure or decompensated cirrhosis
175
Anticoagulant of choice in DVT
DOAC first line | If not suitable then LMWH
176
ADRs of isoniazid
Polyneuropathy | Hepatotoxic
177
ADRs of rifampicin
Pink secretions | Hepatotoxicity
178
ADRs of pyrazinamide
Gout | Hepatotoxicity
179
ADRs of ethambutol
Optic neuritis
180
Monitoring of TB meds
Baseline LFTs then routine LFT monitoring
181
What should be co-prescribed with isoniazid?
pyridoxine (reduce risk of neuropathy)
182
Second line to statins
Ezetimibe
183
MOA of ezetimibe
Reduces bile secretion to minimise fat absorption
184
MOA of ivabradine
Inhibits funny current to reduce heart rate
185
MOA of nicorandil
Calcium channel blocker
186
MOA of ransolazine
Sodium channel blocker
187
Medication following an MI
Beta-blocker ACE inhibitor Statin Anti-platelet for a year
188
What is entresto?
a combination of sacubitril and valsartan which acts as a diuretic and ARB
189
Medication to treat prolactinoma
Cabergoline
190
MOA of cabergoline
Dopamine agonist
191
MOA of tolvaptan
ADH inhibitor
192
Medication to treat SIADH
tolvaptan
193
First line medication in hyperthyroidism
Carbimazole
194
Second line medication in hyperthyroidism
Propylthiouracil
195
Contraindication to carbimazole
First trimester
196
What allergies are contraindications to naseptin?
Peanut and soya
197
First line in Wilson's disease
D-penicillamine
198
MOA of D-penicillamine
Copper chelating agent (increases excretion)
199
Contraindication of ramipril
Severe renal failure
200
Test prior to starting ramipril
U&Es
201
Monitoring of ramipril
U&Es 1-2 weeks after initiation or increasing dose (check for renal damage)
202
MOA of phenobarbital
Anti-convulsant
203
First line in most epilepsy
Sodium valroate
204
First line in focal epilepsy
Carbamazepine
205
Second line anti-epileptics
carbamazepine, lamotrigine, levetiracetam and phenytoin
206
MOA of carbamazepine
Anti-epileptic
207
MOA of phenytoin
Anti-epileptic
208
MOA of levetiracem
Anti-epileptic
209
MOA of lamotrigine
Anti-epileptic
210
What is in tazocin?
Penicillin and tazobactam
211
What is in co-amoxiclav?
Amoxicillin and cluvanic acid
212
Pre-eclampsia medication to avoid around birth
Methyl-dopa
213
Second line meds in pre-eclampsia
Nifedipine or methy-dopa
214
Indication for Hydroxycarbamide/Hydroxyurea
Sickle cell (various indications)
215
Medication for pre-eclampsia prophylaxis
Aspirin
216
What meds should be given prior to anticipated pre-term labour?
Steroids or magnesium sulphate (helps with lung maturation)
217
Abx used in bacterial vaginosis
Metronidazole
218
Abx used in siphilis
Single dose IM penicillin
219
Abx used in gonorrhoea
Single dose of IM ceftriaxone
220
First line in manic episode
Antipsychotic
221
Medication to reduce intraocular pressure
IV acetazolamide
222
Indications for denosumab
Osteoporosis | Hypercalcaemia of malignancy
223
Diuretic of choice in ascites
Aldosterone antagonist e.g. spironolactone
224
ADRs of sulphonamides
hyperkalaemia headache rash
225
MOA of bivalirudin
Anticoagulant
226
MOA of paclitaxel
Microtubule modifier
227
MOA of irinotecan
Topoisomerase inhibitor
228
MOA of cyclophosphamide
Alkylating agent / immunosuppressant
229
Monitoring of letrozole
Bone density monitoring before and during treatment
230
Serious ADR of tamoxifen
Endometrial cancer
231
MOA of flourouracil
Antimetabolite
232
MOA of imatinib
Tyrosine kinase inhibitor
233
Indication for imatinib
CML
234
Indication for trastuzumab
HER2 positive breast cancer
235
MOA of trastuzumab
Monoclonal antibody against HER2 receptor
236
MOA of sipuleucel-T
Dendritic cell therapy
237
Anti-epileptic safest in pregnancy
Lamotrigine
238
Route of administration of fentanyl
Patch / tablet / spray / lozenge
239
Indication for oxycodone (over morphine)
Renal failure | Hallucinations / itching with morphine
240
Adjustment of morphine dose for oxycodone
Halve morphine dose
241
Typical starting prescription for morphine
10mg oramorph PO 4 hourly (5 if frail or not previously on opioid) 10mg hourly PRN breakthrough doses
242
Conversion of morphine dose to sustained release morphine (MST / zomorph)
Total morphine in 24 hours divided by 2 = MST dose BD
243
What is MST?
Modified release morphine
244
What is zomorph?
Modified release morphine
245
Typical dose titration in morphine
Increase baseline and breakthrough dose by 30 - 50% (typically 10mg -> 15mg -> 20mg)
246
Conversion of oral morphine dose to SC dose
Halve oral morphine dose
247
Early signs of opioid toxicity
Sleepiness Hallucinations Myoclonic jerks Confusion or mental clouding
248
Management if bony pain in oncology
Analgesic ladder Radiotherapy typically very effective after a couple of weeks Consider bisphosphonates or surgical fixation
249
Effect of metoclopramide on gastric emptying
Speeds up gastric emptying
250
MOA of donperidone
Anti-emetic
251
MOA of cyclizine
Histamine antagonist and anticholinergic (anti-emetic)
252
First line in "chemical" nausea
Haloperidol
253
First line in nausea due to raised ICP
Cyclizine (and dexamethasone to reduce ICP)
254
First line in vestibular nausea
Cyclizine
255
First line in cortical (anxiety) nausea
Lorazepam
256
First line in obstructed bowel nausea
Buscopan (reduce gut motility) | Haloperidol (anti-emetic)
257
First line in delayed gastric emptying nausea
metoclopramide
258
Indication for pirfenidone
Pulmonary fibrosis
259
Medications associated with hyopnatraemia
Diuretics, ACE inhibitors, amitriptyline, anti-psychotics, anti-epileptics, chemotherapy, PPIs
260
Medications associated with hypercalcaemia
Thiazides, lithium, vitamin D, vitamin A, calcium
261
Medications associated with hypokalaemia
Loop diuretics, thiazide diuretics, insulin, salbutamol
262
Medications associated with hyperkalamia
ACE inhibitors, ARBs, NSAIDs, aspirin, K+ sparing diuretics, beta blockers
263
Symptoms of serotonin syndrome
Neuromuscular excitation e.g. tremor / hypertonia Autonomic symptoms e.g. sweating Psychiatric symptoms e.g. agitation
264
Contraindications for COCP
``` Over 50 Migraine with aura Smoker over 30 Within 6 weeks of birth More than 1 risk factors for heart disease (e.g. HTN, smoking, diabetes, obesity) History of clots ```
265
MOA of amphotericin
Anti-fungal
266
ADRs of hyoscine butyl bromide
constipation, dry mouth, and urinary retention
267
MOA of hyoscine butyl bromide
Anti muscarinic
268
Indication for hyoscine butyl bromide
Abdominal cramping
269
MOA of prochlorperazine
Anti emetic
270
Route of administration of triptans in adults
Oral
271
Route of administration or triptans in under 18s
Nasal
272
MOA of pentoxifylline
Peripheral vasodilator
273
Indication for oral pentoxifylline
Venous ulcer
274
ADRs of azathioprine
bone marrow depression nausea/vomiting pancreatitis increased risk of non-melanoma skin cancer
275
What drug seriously interacts with azathioprine?
Allopurinol
276
Drug used in general anaesthesia
Propofol
277
First line in anti phospholipid syndrome
Heparin
278
What anticoagulant is used in pregnancy
Heparin
279
Indication for methylphenidate
ADHD
280
Medication co-prescribed with levodopa
Carbidopa
281
MOA of disodium pamidronate
Bisphosphonate
282
MOA of zolendronic acid
Bisphosphonate
283
Serious ADR of tamoxifen
Blood clots
284
Contraindications of benzodiazepines
Severe renal / liver failure CNS / respiratory depression Sleep apnoea
285
Indication for zopiclone
Short term insomnia
286
Contraindications of zopiclone
Severe renal / liver failure CNS / respiratory depression Sleep apnoea
287
Risks of rapid tranquilisation
- Over-sedation causing loss of consciousness - Loss of airway - Cardiovascular collapse: - Arrhythmias / Hypotension / Sudden death - Respiratory depression - Acute dystonia - Neuroleptic Malignant Syndrome - Interaction with medication (prescribed or illicit including alcohol) - Damage to the therapeutic relationship - Underlying coincidental physical disorders
288
First line for rapid tranquilisation
IM lorazepam
289
Second line in rapid tranquilisation if no response
IM haloperidol / olanzapine
290
Second medication in rapid sedation if partial response
Repeat IM lorazepam
291
MOA of procyclidine
Anti cholinergic
292
Pain meds in palliative care
SC Morphine first line | SC Oxycodone second line
293
Anxiety medications in palliative care
SC midazolam
294
Nausea medications in palliative care
SC cyclizine SC levomepromazine SC haloperidol
295
Respiratory secretions medications in palliative care
SC glycopyrronium | SC hyoscine butyl bromide
296
Ibandronic acid MOA
Bisphosphonate
297
Prothrombin complex concentrate dosing
Based on INR and weight
298
Dalteparin MOA
Anticoagulant
299
Tinzaparin MOA
Anticoagulant
300
Monitoring of heparin
Potassium levels at least once per week | Platelets at least once per week
301
ADRs of heparin
Hyperkalaemia Heparin induced thrombocytopenia Bleeding
302
Management of anticoagulants prior to surgery
Discussion with haematology. Consider cover with a shorter acting anticoagulant
303
Management of insulin prior to surgery
Hold on morning of surgery and use sliding scale
304
Management of oral hypoglycaemics prior to surgery
Hold on day of surgery. Consider if sliding scale is necessary
305
Management of anti-platelets prior to surgery
Hold for 7 days prior to surgery
306
Management of diuretics prior to surgery
Hold on day of surgery
307
Management of ACEi / ARBs prior to surgery
Hold on day of surgery
308
MOA of teicoplanin
Glycopeptide antibiotic
309
MOA of vancomycin
Glycopeptide antibiotic
310
Mirtazepine MOA
Antidepressant
311
Indication for bromocriptine
Prolactinoma
312
Drugs affected by acetlyator status
``` isoniazid procainamide hydralazine dapsone sulfasalazine ```
313
MOA of Adalimumab
Anti-TNF antibody
314
Indication for adalimumab
Crohns | RA
315
MOA of etanercept
Anti-TNF
316
Indication of etanercept
Crohns | RA
317
MOA of bevacizumab
Anti VEGF antibody
318
Indications of bevacizumab
Colorectal cancer | Some renal cancer
319
Amiloride MOA
Potassium soaring diuretic
320
Bumetanide MOA
Loop diuretic
321
Misoprostol MOA
Prostaglandin analogue
322
Misoprostol ADRs
Diarrhoea | Abdo pain
323
Effect of progesterone only pill on mensturation
Can cause irregular bleeding
324
ADRs of mifepristone
Abdo pain | Diarrhoea
325
Tranexamic acid MOA
Anti fibrinolytic
326
At what level of HbA1c is metformin started?
56
327
What level of HbA1c with metformin indicates adding another drug
58
328
Criteria for starting GLP-1 mimetic
3 other drugs not controlling diabetes BMI over 35 Or BMI under 35 and insulin would have occupational implications
329
Criteria for continuing a GLP-1 mimetic
HbA1c fall by at least 11 and 3% weight loss in 6 months
330
Indications for cytarabine
AML
331
Indication for hydroxycarbamide
Sickle cell
332
MOA of bleomycin
Antibiotic
333
MOA of doxorubicin
Antibiotic
334
ADRs of methotrexate
Myelosuppression, mucositis, liver and lung fibrosis
335
ADRs of cyclophosphamide
Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma
336
ADRs of fluorouracil
Myelosuppression, mucositis, dermatitis
337
MOA of cytarabine
Anti metabolite
338
MOA of vincristine
Microtubule inhibitor
339
MOA of vinblastine
Microtubule inhibitor
340
MOA of docetaxel
Microtubule inhibitor
341
Azathioprine ADRs
Bone marrow depression N&V Pancreatitis Non melanoma skin cancer
342
Enzyme to test before starting azathioprine
Thiopurinemethyltransferase test (TPMT) as deficiency in this enzyme increases risk of toxicity
343
Use of thiopental
Anaesthetic
344
Use of etomidate
Anaesthetic
345
First line in maturity onset diabetes of the young
Sulfonylurea
346
Sulfonylureas ADRs
Hypoglycaemia Weight gain Less commonly, hyponatraemia, myelosuppression, hepatotoxicity, neuropathy
347
ADRs of erythromycin
GI side effects | Cholestatic jaundice
348
Indication for stemetil
Vertigo / sickness
349
Indication of cholestryramine
Itch in patients with liver disease
350
MOA of felodipine
Calcium channel blocker
351
Indication of felodipine
HTN
352
Medication to treat iron overload in haemochromatosis
Desferrioxamine
353
MOA of desferrioxamine
Iron cheating agent
354
Medication used in Wilson’s disease
Trientine
355
MOA of trientine
Copper chelating agent
356
ADRs of metoclopromide
extrapyramidal effects: oculogyric crisis. This is particularly a problem in children and young adults hyperprolactinaemia tardive dyskinesia parkinsonism
357
Contraindications of tetracyclines
Children under 12 Pregnancy women (Due to risk of tooth discolouration)
358
ADRs of tetracyclines
discolouration of teeth: therefore should not be used in children < 12 years of age photosensitivity angioedema black hairy tongue
359
Management of hepatotoxicity in patients being treated for TB
Stop all TB meds | Once LFTs have stabilised re-start meds with a reintroduction or alternate regime
360
Felodipine MOA
Calcium channel blocker
361
What is septrin?
Cotrimoxazole
362
Cisplatin MOA
Damages DNA
363
Propofol MOA
Potentiates GABA receptors
364
Propofol ADRs
Pain on injection | Hypotension
365
Why might bupivacaine be chosen over lidocaine?
Longer duration of action
366
What drug is often added to bupivacaine to improve the action
Diamorphine
367
What is xylocaine?
Combination of lidocaine and adrenaline
368
What type of anaesthetic is ketamine?
General
369
Cautions / contraindications for contrast
Asthma Renal impairment Metformin Iodine allergy
370
MOA of carbocysteine
Mucolytic
371
MOA of pigvisomant
Growth hormone antagonist
372
MOA of bromocriptine
Dopamine agonist
373
ADR of chloramphenicol
Aplastic anaemia
374
MOA of solifenacin
Anticholinergic
375
MOA of tolterodine
Anticholinergic
376
MOA of oxybutynin
Anticholinergic
377
MOA of mirabegron
Beta agonist
378
Drugs associated with agranulocytosis
Antithyroid drugs - carbimazole, propylthiouracil Antipsychotics - atypical antipsychotics (CLOZAPINE) Antiepileptics - carbamazepine Antibiotics - penicillin, chloramphenicol, co-trimoxazole Antidepressant - mirtazapine Cytotoxic drugs - methotrexate
379
MOA of dasatinib
Tyrosine kinase inhibitor
380
MOA of nilotinib
Tyrosine kinase inhibitor
381
MOA of bosutinib
Tyrosine kinase inhibitor
382
First line in ITP
Steroids
383
Common ADRs of hydroxyurea
Myelosuppression
384
Medications that interact with warfarin
Amiodarone | Many antibiotics and antiepileptics
385
Foods that can interact with warfarin
Green leafy veg | Fruit juices eg cranberry / grapefruit/ green tea
386
Management of major bleeding in patient on warfarin
ABCDE, stop warfarin, commence IV vitamin K and IV prothrombin complex concentrate
387
Management of INR >8 in patient with no bleeding or minor bleeding
Vitamin K. Stop warfarin, restart once INR < 5.0. The INR should be rechecked in 24 hours and if still high then repeat vitamin K
388
Management of INR 5-8 with no bleeding or minor bleeding
stop warfarin and recommence when INR < 5.0
389
ADRs of warfarin
Jaundice, hepatic necrosis, haemorrhage, hypersensitivity, rash, diarrhoea, and skin necrosis.
390
Contraindications of warfarin
Pregnancy, bacterial endocarditis, severe hypertension, peptic ulcer
391
What pain medication may be used in severe renal failure?
Alfentanil
392
ADRs of aromatase inhibitors
Joint aches | Bone thinning
393
ADRs of tamoxifen
``` Hot flushes Weight gain Fatigue Increased risk of VTE Increased risk of endometrial cancer ```
394
ADRs of trastuzumab
Cardiac toxicity
395
MOA and indication for strontium ranelate
Inhibitor bone resorption so used in oesteoporosis
396
MOA and indication for teriparatide
Synthetic PTH used in osteoporosis
397
Administration method of densusomab
SC injection every 6 months
398
Denosumab ADRs
Dyspnoea | Diarrhoea
399
Indication for olaparib
Some patients with BRCA mutations
400
MOA of methodone
Mu receptor agonist
401
MOA of naloxone
Mu receptor antagonist
402
MOA of flumazenil
GABA antagonist
403
MOA of memantine
NMDA antagonist
404
MOA of benzodiazepines
GABA agonist
405
First line drug option in urge incontinence
Oxybutynin
406
Medication option in stress incontinence
Duloxetine
407
Medication to add after ICS in childhood asthma
Montelukast
408
MOA of quetiapine
Antipsychotic
409
MOA of venlafaxine
Antidepressant
410
MOA of mirtazepine
Antidepressant
411
Effect of POP on periods
Lighter
412
Effect of IUS on periods
Lighter but may be irregular
413
ADRs of NSAIDs
Bronchospasm Renal complications Dyspepsia Skin reactions
414
First line antibiotic in C.diff
Vancomycin (oral)
415
Antibiotic of choice for prophylaxis against group B strep in neonates of colonised mothers
Benzyl penicillin
416
MOA of exenatide
SC
417
Is warfarin safe in pregnancy?
No it’s teratogenic
418
Is LMWH safe in pregnancy and breastfeeding?
Yes but caution if the mother may go into Labour (as it’s difficult to reverse)
419
Drugs used in medical miscarriage
Mifepristone and misoprostol
420
Medication for pre eclampsia prophylaxis
Aspirin
421
Drugs to avoid in pregnancy
``` antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone ```
422
Ipratropium length of action
Short acting
423
Length of action of tiotropium
Long
424
First line in uterine hyperstimulation
Terbutaline
425
First line to delay delivery in preterm labour
Nifedipine
426
Monitoring of methylphenidate
Growth | Pulse and BP
427
Next step in management of COPD with symptoms on salbutamol and no asthmatic features
Add LAMA and LABA
428
First line in DVT
DOAC
429
What medication is contraindicated in gout?
Thizides
430
Treatment of scabies in close contacts
2 doses permethrin a week apart
431
Can ACE inhibitors be used in pregnancy?
No
432
Can ACE inhibitors be used in breastfeeding?
No
433
Can statins be taken in pregnancy?
No
434
Drug that interacts with statins
Clarithromycin / erythromycin
435
Indication for statin
Established cardiovascular disease QRISK2 score indicates over 10% risk of CVD in the next 10 years T1DM diagnosed over 10 years ago
436
What time of day to take statins
Night
437
Indication for isotretinoin
Severe acne
438
Drugs to stop in AKI
``` ACE inhibitors ARBs NSAIDs Diuretics Aminoglycosides Lithium Metformin ```
439
First line pharmacological cardioversion in AF
Amiodarone
440
Antidepressants contraindicated in patients on alteplase
SSRIs or SNRIs
441
ADRS of SSRIs
``` GI upset Prolonged QT Sexual dysfunction Insomnia Headache ```
442
Test before starting SSRIs
ECG to look for long QT
443
ADRs of SNRIs
``` GI upset Sexual dysfunction Insomnia Headache HTN ```
444
What patients typically benefit from mirtazapine as an antidepressant?
Patients with sleep problems or poor appetite
445
ADRs of mirtazapine
Increased appetite and weight gain Sedative Sexual dysfunction
446
Indication for procyclidine
ADRs from antipsychotics (e.g. oligouric crisis)
447
First line in hypomania
Quetiapine
448
first line mood stabiliser
Lithium
449
Second line mood stabiliser
Sodium valproate
450
What does disulfiram do?
Causes vomiting with alcohol to act as a deterrent
451
Treatment of local anaesthetic reaction
Lipid emulsion
452
Contraception options in woman after childbirth
POP, IUD, IUS
453
Drug that may be used alongside insulin in T1DM
Dapagliflozin
454
How long for POP to be effective?
48 hours
455
What is filgrastim?
A granulocyte-colony stimulating factor used in neutropaenia
456
What anaesthetic is good in haemodynamically unstable patients?
Ketamine
457
Dose of adrenaline in cardiac arrest
1mg
458
EPO ADRs
Bone ache, skin rash, flu-like symptoms
459
Adenosine ADRs
Chest pain Bronchospasm Flushing
460
First line in patients with angina and heart failure
Atenolol
461
What shouldn't be prescribed with verapamil?
Beta blocker
462
What drug should be held for 48 hours prior to contrast
Metformin
463
Which beta blocker is used first line in thyrotoxicosis prophylaxis?
Propanolol
464
Medication that may be used in stress incontinence
Duloxetine
465
Levodopa ADRs
N&V, hypotension, sleep disturbance, confusion, hallucinations, delusions, dyskinesias, dystonia, tolerence
466
What is co-careldopa?
Levodopa and carbidopa
467
What is co-beneldopa?
Levodopa and benserazide
468
What class of drugs are often second line in Parkinsons
Dopamine agonists
469
What routes can dopamine agonists be administered via?
Oral, patch, injections
470
ADRs of dopamine agoinsts
nausea, constipation, hypotension, headache, dyskinesias, sudden sleep, hallucinations, impulse control disorders
471
Pamiprexole MOA
Dopamine agonist
472
Ropinerole MOA
Dopamine agonist
473
Rotigotine MOA
Dopamine agonist
474
Apomorphine MOA
Dopamine agonist
475
Interactions of monoamine oxidase B inhibitors
Antidepressants, decongestants
476
ADRs of MAO-B inhibitors
GI disturbance, hypotension, urinary frequency, mood changes
477
MOA of rasagiline
MOA-B inhibitor
478
MOA of selegiline
MOA-B inhibitor
479
MOA of safinamind
MOA-B inhibitor
480
MOA of entacapone
COM-T inhibitor (potentiates levodopa)
481
MOA of opicapone
COM-T inhibitor (potentiates levodopa)
482
MOA of tolcapone
COM-T inhibitor (potentiates levodopa)
483
What medication is COM-T inhibitors taken with?
Levodopa
484
How long after pregnancy before starting COCP
21 days
485
First line in acute pericarditis
NSAID and colchicine
486
Management of thyroxine in pregnancy
Increase dose (typically by up to 50% in first 4-6 weeks
487
Which areas should emollients be applied to?
Whole skin
488
ADRs of topical steroids
Skin thinning / striae
489
Topical immunomudulators
Tacrolimus / pimecrilimus
490
Topical treatments in mild acne (commedones)
Benzoyl peroxide, retinoin, abx
491
When to use oral abx in acne
Papules / pustules not cleared with topical therapy
492
Isotretinoin indication
Severe acne
493
ADR of isotretinoin
Teratogenic, dry lips
494
Indication for cyproterone acetate
Seborrhoea in women with acne
495
Topical treatments considered in psoriasis
Emollients, Salicylic acid (helps other treatments), steroids, tar preparations, dithranol (specialist), vitamin D/A
496
Who should be treated with permethrin?
All household contacts
497
How to apply treatment for scabies / lice
Two courses a week apart
498
First line in delirium
Haloperidol
499
First line in delirium for patients with Parkinsons
Lorazepam
500
Tests before IV acyclovir
renal function
501
Donepezil MOA
Acetylcholine esterase inhibitor
502
Rivastigmine MOA
Acetylcholine esterase inhibitor
503
Galantamine MOA
Acetylcholine esterase inhibitor
504
ADRs of Acetylcholine esterase inhibitors
GI upset
505
Cautions for Acetylcholine esterase inhibitors
Asthma / COPD, some arrhythmias or conduction disorders
506
Memantine ADRs
Dizziness, balance issues, headache, drowsiness
507
What shouldn't be co-prescribed with verapamil?
Beta blocker
508
Anticoagulation after ablation of AF
Continue as per CHADsVASc
509
Vancomycin moniotring
Trough levels and renal function
510
What should be given with co-trimoxazole?
Anti-emetic
511
Co-trimoxazole ADRs
N&V, rash, bone marrow suppression, hepatotoxicity, hypoglycaemia
512
Co-trimoxazole monitoring
FBC, U&Es, LFTs
513
Digoxin toxicity symptoms
Nausea, vomiting, diarrhoea, hallucination, visual disturbance, drowsiness
514
Dose conversion codeine to morphine
Divide by 10
515
Tamsulosin ADRs
dizziness, postural hypotension, dry mouth, depression
516
Finasteride ADRs
Erectile dysfunction and ejaculation problems, reduced libido, gynaecomastia
517
Budesonide MOA
ICS
518
Dantrolene indication
Neuroleptic malignant syndrome
519
Phenytoin monitoring
Trough levels if dose change or concern of toxicity
520
Paroxetine MOA
SSRI
521
Venlafaxine MOA
SNRI
522
Clomipramine MOA
TCA
523
Clomipramine indication
OCD
524
Monitoring of statins
LFTs at baseline, 3 months and 12 months
525
Which antibiotic shouldn't be mixed with alcohol?
Metronidazole
526
Glimepiride MOA
Sulfonylurea
527
Methylphenidate monitoring
Height and weight
528
Methylphenidate key ADR
Growth restriction
529
Important ADR of hydroxychloroqiune
Retinopathy
530
Chlorpromazine MOA
Antipsychotic
531
Mesalazine ADRs
GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis
532
Which antipsychotic is less likely to cause weight gain?
Aripiprazole
533
When to stop antidepressants
6 months after symptoms resolved
534
Carbamazepine ADRs
rash, dizziness, hyponatremia, hair thinning. Also inhibits COCP.
535
Lamotrigine ADRs
rash, flu-like symptoms and destruction/ulcers in mucous membranes (Stevens-Johnson syndrome)
536
Gabapentin ADRs
drowsiness, abnormal eye movements, GI upset, dry mouth
537
Valproate ADRs
tremor, weight gain and hair thinning, teratogenic
538
Phenytoin ADRs
Gum hypertrophy and hirsutism, coarse face and acne. Also inhibits COCP
539
Antibiotic associated with tendon rupture
Ciprofloxacin
540
What medications to avoid with SSRI (as increases risk of serotonin syndrome)
Triptans
541
Orlistat MOA
Lipase inhibitor
542
Severe C diff treatment
Oral vancomycin and IV metronidazole
543
Strontium ranelate indication
Osteoporosis
544
Strontium ranelate MOA
Inhibits osteoclasts
545
Phenoxybenzamine MOA
Alpha blocker
546
Colchicine ADRs
GI side effects
547
Allopurinol ADRs
Rash
548
What drug is antabuse?
Disulfiram
549
Acamprosate indication
Reduces alcohol cravings
550
What can be used as alternative to methadone?
Buprenorphine
551
RA medication in pregnancy
Hydroxychloroquine
552
Drugs to improve prognosis in MND
Riluzole, Edaravone
553
Management of HRT prior to surgery
Stop 4 weeks prior to elective surgery to reduce risk of VTE
554
Nifedipine MOA
Calcium channel blocker
555
Medication to avoid in chickenpox
NSAIDs
556
Solifenacin MOA
Anticholinergic
557
Treatment of DVT in pregnancy
Enoxaparin
558
What type of heparin does LMWH reverse?
Unfractionated
559
Pyrazinamide ADRs
Gout, arthropathy, hepatotoxicity
560
Medication to consider in warts
Topical salicylic acid
561
Bupropion indication
Smoking cessation
562
Second line mood stabiliser
Sodium valproate
PSA
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