MRCP Clinical pharmacology
MRCP Clinical pharmacology
Pregnancy and Thyroid Hormone - answer-Pregnancy increases the amount of TBG (thyroid binding globulin) so increases the total thyroxin levels but not free thyroxine
Hyperthyroid in pregnancy - answer-Untreated - fetal loss, premature lab...
MRCP Clinical pharmacology
Pregnancy and Thyroid Hormone - answer-Pregnancy increases the amount of TBG (thyroid
binding globulin) so increases the total thyroxin levels but not free thyroxine
Hyperthyroid in pregnancy - answer-Untreated - fetal loss, premature labour, maternal heart
failure
Graves disease most common
HCG can activate TSH receptors - transient gestational hyperthyroid - these fall in trimester 2 &
3
treatment - propylthiouracil in first trimester
this can cause hepatic injury
carbimazole in 2nd trimester once lower risk of congenital abnormalities
Monitoring - free thyroxine levels should be kept upper third normal so to avoid fetal
hypothyroid
- thyrotrophin receptor stimulating antibodies should be checked weeks 30-36
DO NOT - block and replace or use radioiodine.
Hypothyroid in pregnancy - answer-Thyroxine replacement is safe in pregnancy and
breastfeeding
TSH measured each trimester and 6-8 weeks post partum
Women often require an increased dose - up to 50% by weeks 4-6
untreated - developmental abnormalities, miscarriage, still birth, low birth weight, pre-eclampsia,
anaemia
Gentamicin - answer-Aminoglycoside antibioitic
Given IV or topically
Ototoxic - irreversible due to auditory or vestibular nerve damage
Nephrotoxic - causes tubular necrosis, accumulates in renal failure requiring increased
monitoring, furosemide increases this risk
CI - Myasthenia Gravis
Dosed via height and weight and renal function. Peak and trough levels monitored with dose
adjustments based on trough levels
CSF: Protein levels - answer-normal = 0.2-0.4 g/L
Causes of raised CSF protein
GBS
Froin's syndrome - a spinal canal blockage characterised by xanthochromia, raised protein and
CSF hypercoagulability
TB, bacterial or fungal meningitis
viral encephalitis
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Vigabatrin - answer-Irreversibly inhibits GABA transaminase-->increased GABA levels in
synapse
Uses = tx infantile spasms (Viga"Baby"trin)
Or used as adjunct therapy for adults with refractory complex partial seizures
SE = visual field constriction and even visual loss in 40% of patients- visual fields must be
checked every 6 months as visual loss can be irreversible
Corticosteroid side effects - answer-COME IN PIGG
Cushings
opthalmic - glaucoma, catterachts
M - musculoskeletal - OP, proximal myopathy, avascular necrosis
Endocrine- hyperglycaemia, weight gain, hirsuitism, high lipids
Immunosupression
Neutrophilia
Psychiatric - mania, psychosis, insomnia, depression
Intracranial hypertension
Gastric - pancreatitis, ulcers,
Growth suppression in kids
Acne - Systemic glucocorticoids can cause drug-induced acne. This is characterised as
monomorphic papular rash without comedones or cysts. This does not respond to acne treatment
but improves on drug discontinuation
Therapeutic Steroids - answer-Fludocortisone - mostly mineralocorticoid
hydrocortisone - some glucocorticoid, some mineralocoticoid
Dexamethsone - high glucocorticoid
Medication overuse headache - answer-Headache for over 15 days a month, whilst taking regular
analgesia
triptans and opioids are highest risk
very common, can affect 1/50 people
management - stop simple analgesia and triptans, wean down any opioids
the headaches may initially worsen before getting better in severity and duration
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