Random PSA Facts

Question 1

Which medications can lower the seizure threshold?

Answer 1

• Quinolone antibiotics (e.g. Ciprofloxacin)

Question 2

Paracetamol antedote

Answer 2

Acetylcysteine

Question 3

Factors which may contribute towards lithium toxicity

Answer 3

• dehydration
• renal failure
• medications

Question 4

Name some medications which can increase the risk of lithium toxicity if taken together

Answer 4

• Thiazide diuretics
• ACE inhibitors / ARBS
• NSAIDs
• Metronidazole

Question 5

Features of lithium toxicity

Answer 5

• Coarse tremor
• Hyperreflexia
• Acute confusion
• Polyuria
• Seizure
• Coma

Question 6

First line / important early intervention in management of bleach consumption

Answer 6

Early endoscopy and risk stratification

Question 7

Which TB drug reduces INR?

Answer 7

Rifampicin (P450 enzyme inductor)

Question 8

Common reaction to N-acetylcystine

Answer 8

Anaphylactoid reaction (from non-IgE mediated mast cell release)

Question 9

Medications contraindicated in the use of Sildenafil

Answer 9

Contraindicated by nitrates and nicorandil (PDE 5 inhibitors)

Question 10

What investigation result is the main factor for determining liver transplant in paracetamol overdose patients?

Answer 10

pH

pH < 7.3 more than 24 hours after ingestion

Question 11

Name some drugs that can cause urinary retention

Answer 11

• Tricyclic antidepressants
• anticholinergics
• opioids
• NSAIDs
• disopyramide

Question 12

Lorazepam antidote

Answer 12

Flumazenil

Question 13

Methanol antidote

Answer 13

Ethanol

Question 14

Digoxin antidote

Answer 14

Specific antibody fragments

Question 15

What type of medications can reduce platelet count?

Answer 15

anticoagulants

Question 17

Name some types of nephrotoxic drugs

Answer 17

• Aminoglycazides (gentamicin)
• ## NSAIDs

Question 18

What does the DoTS classification system assess about ADRs?

Answer 18

The dose relationship
Time dependency
Patient susceptibility

Question 19

What should be included in a valid report to the yellow card scheme?

Answer 19

• identifiable patient
• suspected reason for the ADR
• a suspected drug
• a reporter

Question 20

The Ywllow card scheme recieves reports about _______

Answer 20

suspected ADRs in the UK

Question 21

Name some clinical signs of rhabdomyalysis

Answer 21

• muscle swelling
• tenderness
• weakness
• brown urine (myoglobin)
• elevated CK values (10 - 100 x normal value)

Question 22

Rhabdomyalysis can cause which electrolyte imbalance?

Answer 22

Hyperkalaemia (raised K+)

Question 23

Name some factors which increase the risk of rhabdomyalysis

Answer 23

• pre-existing renal impairement
• sex of patient
• statins

Question 24

What is an adverse event?

Answer 24

any harmful or unpleasant event that the patient experiences while using a drug, whether or not it is related to the ddrug

Question 25

What is an adverse drug reaction (ADR)?

Answer 25

An adverse event where it is suspected to be caused by the drug

Question 26

What are the 3 types of dose reactions?

Answer 26

- hypersusceptibility reactions - collateral effects - toxic effects

Question 27

What do time dependent and independent mean?

Answer 27

dependent: those which are dependent on the time the patient has been taking the drug independent: those which occur at any time during drug treatment, regardless of how long the patient has been taking the drug (may be that their kideys are deteriorating and could increase conc of drug, causing toxicity...)

Question 28

What is a rapid reaction? Give an example

Answer 28

When a drug is administered too quickly Vancomycin flushing syndrome, following rapid infusion of vancomycin

Question 29

What is an early reaction? Give an example

Answer 29

Occurs in early treatment the abates with continuous treatment (tolerance) Nitrate induced headache

Question 30

What is a first dose recation? Give an example

Answer 30

Occurs after the first dose Hypotension with ACE-inhibitors

Question 31

What is an intermediate reaction? Give an example

Answer 31

Occurs after some delay, if a reaction does not occur after a certain time, then little to no risk exists Some allergic reactions

Question 32

What is a late reaction? Give an example

Answer 32

Risk of ADR increases with continued or repeated exposure, including withdrawl reactions Withdrawing long term steroids

Question 33

What is a delayed reaction?

Answer 33

Occurs some time after exposure, even if the drug is withdrawn e.g. Teratogenicity

Question 34

Name some susceptibilities which can increase the risk of ADRs (IGASPED)

Answer 34

I GASPED - Immunological reactions (e.g. allergies) - Genetics (e.g. G6PD deficiency) - Age - Sex - Physiology (e.g. pregnancy) - Exogenous (e.g. other drugs the patient may already be taking, foods, temperatures) - Disease states affecting the patient (e.g. renal dysfunction, liver disease)

Question 35

What is the Rawlins-Thompson system of classifying ARDs?

Answer 35

Type A: Augmented / common and predictable Type B: Bizzare Type C: Chronic Type D: Delayed Type E: End of treatment Type F: Failure

Question 36

Why are children more susceptible to ADRs?

Answer 36

- Higher body water content - Lower albumin and total protein levels - An immature blood-brain barrier

Question 37

Name some chronic conditions which elevate risk of ADRs

Answer 37

- COPD - Congestive cardiac failure - Diabetes - Rheum and malignant diseases

Question 38

Why are females often more susceptible to ADRs?

Answer 38

- on average smaller than males, standardised dosing

Question 39

Name some drugs females are more likely to have ARDs from?

Answer 39

- Mefloquine (malarial drug), psych effect - Drug induced torsades de point - Hyponatraemia associated with diuretics

Question 40

Patients of African-Caribbean origin are more likely to experience angioedema when prescribed ____________

Answer 40

ACE inhibitors

Question 41

What gene is associated with a higher risk of Stevens-Johsnon syndrome? Name some of the common causative drugs

Answer 41

HLA-B*1502 - lamotrigine - carbamazepine - phenytoin - oxcarbazepine

Question 42

G6PD increases risk of drug induced _________________

Answer 42

haemolytic anaemia

Question 43

Standard monitoring on Clozapine

Answer 43

WBCs Platelets Neutrophils (agranulocytosis risk)

Question 44

Standard monitoring on Warfarin

Answer 44

- FBC - U&E - LFTs

Question 45

Standard warfarin monitoring

Answer 45

- INR

Question 46

Name 2 drugs that require plasma drug concentration monitoring

Answer 46

- Lithium (every 3 months) - Aminoglycosides