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PSA/Pharm Flashcards

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1
Q

what is the treatment for acute dystonia/oligouric crisis?

A

procyclidine 10 mg iv STAT

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2
Q

what cardiovascular medications are contraindicated in peripheral vascular disease?

A

all - beta-blockers because they reduce peripheral limb perfusion through action on the adrenergic system

severe PVD - also avoid ACE-I

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3
Q

what are some commonly used mediations that worsen congestive heart failure?

A
  • calcium-channel blockers
  • NSAIDs
  • DPP-4 inhibitors (sitagliptin)
  • alpha-blockers (doxazosin)
  • anti-arrhythmics (sotalol, flecanide, disopyramide)
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4
Q

name the commonly used thiazides and thiazide-like diuretics

A
  • bendroflumethiazide
  • hydrochlorothiazide
  • indapamide
  • chlorthalidone
  • metolazone
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5
Q

name the common used cardioselective calcium channel blockers

A
  • verapamil
  • diltiazem
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6
Q

name the common peripherally acting calcium channel blockers

A
  • amlodipine
  • nifedipine
  • nimodipine
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7
Q

which antibiotics should be avoided when a patient is on methotrexate?

A

trimethoprim and fluroquinolones

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8
Q

what medication seriously increased the risk of myotoxicity when given in combination with a statin?

A

gemfibrozil

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9
Q

what should be checked before starting a patient on spironolactone or eplerenone?

A

serum potassium

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10
Q

what should be told to patients on methotrexate?

A
  • blood disorders (infections, bleeding, anaemia, ulcers)
  • liver toxicity (dark urine, nausea and vomiting)
  • respiratory effects (shortness of breath)
  • NSAIDs - should be avoided, but not absolutely CI
  • teratogenicity - both men and women should be on contraception for the duration of treatment and 3 months after stopping
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11
Q

which NSAIDs have the highest and lowest CV risk associated?

A

highest - coxibs and diclofenac

lowest - naproxen

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12
Q

what is the mechanism of action of thiazide diuretics?

what are the common side effects of thiazide diuretics?

A

inhibiting sodium reabsorption in the distal convoluted tubule through the Na-Cl symporter. potassium is lost as a result of more Na reaching the DCT and collecting ducts

common:

  • dehydration & postural hypotension
  • hyponatraemia, hypokalaemia, hypercalcaemia
  • gout
  • impotence

rare:

  • photosensitive rash
  • thrombocytopenia
  • agranulocytosis
  • pancreatitis
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13
Q

what are the main serious side effects of NSAIDs?

A
  • worsening of asthma
  • increased risk of thromboembolic (MI or CVA) events
  • increased risk of GI-ulceraiton and haemorrhage
    • worsened if drinking alcohol in moderate quantities concurrently
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14
Q

what are the fluid and electrolyte requirements for an adult in 1 day?

what is the minimum urine output target?

A

fluid - 40 mL/kg

Na+ - 2 mmol/kg

K+ - 1 mmol/kg

0.5 mL/kg/hour

…do not exceed an infusion rate of 10 mmol/hr K+

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15
Q

what a suitable dose of any LMWH for treatment of VTE?

what are the treatment doses of rivaroxaban and apixaban for VTE?

A

enoxaparin - 1.5 mg/kg OD s/c every day until adequate oral anticoagulation is established

rivaroxaban - 15 mg BD for 21 days taken with food

apixaban - 10 mg BD for 7 days, then 5 mg BD

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16
Q

what medication can lead to gingival hyperplasia?

A

ciclosporin

phenytoin

CCBs

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17
Q

what are the starting and monitoring requirements for warfarin?

what finding would be a contraindication to starting warfarin?

A

measure PT and baseline LFTs, do not hold off the first dose while waiting for PT to come back from the lab
measure the PT and calculate the INR

PT > 5 x ULN then do not use warfarin

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18
Q

what are the monitoring requirements for methotrexate?

what are the side effects?

what is the conception advice?

what drugs should be avoided while on methotrexate?

A
  • low-dose = LFTs
  • high-dose = LFTs and FBC and U&E

myelosupression, liver cirrhosis, pulmonary fibrosis, pneumonitis, mucositis

  • *women**: avoid pregnancy for at least 3 months following MTX therapy
  • *men:** use effective contraception for at least 3 months following MTX therapy

trimethoprim and co-trimoxazole (TMP/SMX)

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19
Q

what are the monitoring requirements for lithium?

what are the target and acceptable levels?

A

lithium levels - check every 3 months, taken 12 hours after last dose (trough)

TFTs and U&E checked every 6 months

  • *target**: 0.8-1.0
  • *acceptable:** 0.4-1.2
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20
Q

what blood test is used to monitor 5-aminosalycylic acids (5-ASAs)?

A

U&Es

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21
Q

what are the side effects common to sulfa drugs?

A
  • rashes
  • oligospermia
  • headache
  • Heinz body anaemia
  • megaloblastic anaemia
  • lung fibrosis
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22
Q

what are the side effects common to 5-ASA drugs?

A
  • GI disturbance
  • agranulocytosis
  • pancreatitis
    • mesalazine >>> sulphasalazine
  • interstitial nephritis
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23
Q

what are the adverse affects of amiodarone?

what are the monitoring requirements?

A
  • slate-grey appearance
  • thyroid dysfunction
  • corneal deposits
  • pulmonary fibrosis/pneumonitis
  • liver fibrosis (ALT > AST)
  • photosensitivity
  • thrombocytopenia at injection sites
  • bradycardia
  • *prior to treatment:** TFTs, LFTs, U&E, CXR
  • *every 6 months:** TFTs and LFTs
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24
Q

what is the impact of NSAIDs on heart failure?

A

NSAIDs worsen heart failure by causing fluid retention, increasing blood pressure and increasing the afterload on an already strained heart

heart failure worsened by NSAIDs

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25
why should 5% glucose not be given to an alcoholic at risk of wernicke's encephalopathy immediately?
when malnourished, all the glucose in the body is diverted to the brain for energy. thiamine is a co-factor for OxPhos. introducing systemic glucose increases the whole body demand for thiamine, so it is diverted away from the brain, leading decreased cerebral oxidative phosphorylation. fill the patient up with thiamine (Pabrinex) first, then give glucose
26
what are the starting and monitoring requirements of statin medications?
get lipid profile (obviously) and LFT before starting LFTs at 3 and 12 months after starting AST/ALT is more than 3x ULN, stop and restart at a lower dose transaminase rise of less than 3x ULN - do not stop medication
27
what is the rare but serious liver side effect of statins?
cholestatic hepatitis (raised ALP and liver damage)
28
which diuretic worsens gout?
thiazides
29
which antibiotics increase the chances of statin-induced myopathy?
macrolides - erythromycin/clarithromycin
30
what proportion of patients will not tolerate AZA therapy? what are the common side effects? what is the uncommon and serious side effect of AZA? what medication should you try next in a patient with IBD?
33% of patients will not tolerate AZA GI side effects, hair loss and skin rash red cell aplasia, pancytopenia 6-mercaptopurine
31
what is the side effect of AZA that is more likely to occur in patients with low TMPT levels/deficiency?
myelosupression
32
which tests are needed if you suspect digoxin toxicity?
ECG and renal function (looking for raised creatinine or hypokalaemia) digoxin level *though there is no absolute number for this. the likelihood of toxicity increases as concentrations rise, but toxicity is indicated by the degree of hypokalaemia*
33
which drugs are directly hepatotoxic? i.e. give raise transaminases without ALP rise
paracetamol overdose statins rifamipicin
34
which drugs give a cholestatic hepatitis?
co-amoxiclav and flucloxacillin nitrofurantoin steroids sulfonylureas
35
what is the rule for calculating the expected PaO2 from the FiO2?
[FiO2 - 10] = expected PiO2
36
what medication can result in a downward-sloping ST segment depression in all leads?
digoxin
37
what are the main ototoxic drugs?
* aminoglycosides * loop diuretics * platinum-based chemotherapy
38
which medication should be avoided in myasthenia gravis?
anti-cholinergics.. i.e. oxybutynin for urinary incontinence
39
when should thiazides be taken?
in the morning if you prescribe at night then the patient will wake up having to pee
40
what is the dosing schedule for common anti-emetics?
metoclopramide and cyclizine given **TDS/8-hourly**
41
which is the anti-emetic dopamine blocker than can be used in parkinson's disease?
domperidone, as it does not cross the BBB metaclopramide should not be used in Parkinson's
42
what are the common drugs that precipitate bronchospasm in asthmatics?
beta-blockers, NSIADs and adenosine note: 10-20% of asthmatics are sensitive if they've been on it before without a problem then they can stay on NSAIDs risk is increased in patients who are middle-aged or those with nasal polyps
43
what is the definition and treatment of a severe flare of UC?
opening bowels \>6 times/day and systemically unwell IV hydrocortisone 100 mg QDS/6-hourly
44
what is the definition of a major bleed on warfarin? i.e. requiring PCC
bleeding causing hypotension or into a confined space (skull)
45
what are the sick day rules for T1DM patients with regards to insulin?
needs to increase the dose of insulin, otherwise will run a higher risk of DKA
46
after how many days should you review the antibiotic therapy for acute otitis media?
5 days
47
after how many days should you review the antibiotic therapy for acute epiglottitis?
3 days
48
what is first line treatment for GAD?
citalopram/escitalopram/fluoxetine
49
what is the first line treatment for depression in adults?
citalopram/escitalopram/fluoxetine/fluvoxamine/paroxetine
50
what is the monitoring requirement before you start valproate?
liver function tests
51
what is the monitoring requirement for clozapine?
FBC checked weekly for at least the first 18 weeks
52
what is the monitoring for phenytoin?
ECG and blood pressure
53
what is the best marker to monitor the response of a pneumonia to antibiotic therapy?
respiratory rate return to normal indicates that the respiratory failure is resolved. ABG would be preferable, but is invasive so RR is often easiest
54
which diuretic is associated with hyponatraemia?
thiazides
55
dose for paracetamol?
1g qds
56
dose for ibuprofen?
200-400 mg tds
57
dose for codeine?
30-60 mg qds
58
dose for co-codamol?
8/500 mg qds 30/500 qds or 'co-codamol 8/500 mg 2 tablets qds'
59
dose for cyclizine?
50 mg tds
60
dose for metaclopramide?
total 30-100 typically 10 mg tds
61
amoxicillin
500 mg tds
62
dose for clarithromycin
500 mg bd
63
dose for lansoprazole
15-30 mg od
64
dose for omeprazole
20-40 mg od
65
dose for aspirin
secondary prevention 75 mg od treatment 300 mg od
66
dose for clopidogrel
75 mg od secondary prevention 300 mg od treatment
67
dose for simvastatin
10-80 mg **ON** start at 40 mg ON if the patient has diabetes or established atherosclerotic cardiovascular disease
68
dose for atenolol
25-100 mg od
69
dose for ramipril
1.25-10 mg od
70
dose for bendroflumethiazide
2.5 mg od give in the morning!
71
dose for furosemide
20 mg od - 80 mg bd can be much higher for renal patients
72
dose for amlodipine
5-10 mg od
73
dose for levothyroxine?
25-200 mcg od
74
dose for metformin?
500 mg od - 1 g bd
75
which drugs worsen seizure control in patients with epilepsy?
* alcohol, cocaine, amphetamines * cirpfloxacin, levofloxacin * aminophylline, theophylline * bupropion * methylphenidate * mefenamic acid
76
what is the rule for dose of oral morphine for breakthrough pain in palliative care?
take 1/6th of daily oral morphine dose for breakthrough pain
77
which opioids are best used in renal impairment?
fentanyl or oxycodone
78
what is the effect of ciclosporin on electrolytes?
hyperkalaemia hyperglycaemia and hyperuricaemia
79
how do you treat vulvovaginal candidiasis? what is the difference in pregnancy?
topical/PV clotrimazole must be prolonged treatment... 7 days usually rather than a single dose
80
T1DM in DKA usually on a basal-bolus what do you do with their regular insulin? is the treatment with fixed-rate or variable-rate insulin for the DKA?
stop the short acting keep the long-acting insulin as normal start them on fixed-rate insulin of 0.1 U/kg/hr
81
what is the advice for patients when treating with loperamide for acute diarrhoea?
loperamide should be taken after each loose stool care not to exceed the maximum dose (16 mg/24 hrs)
82
what is the dose adjustment of insulin when a T1DM patient starts taking steroids for treatment of another disease?
increase the dose by 10%
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