MRCP - Pharmacology Part 1 (Toxicity). Exam Questions With Correct Answers
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MRCP
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MRCP
MRCP - Pharmacology Part 1 (Toxicity).
Exam Questions With Correct Answers
LFTs at baseline, 3 mo and 12 mo - answerWhat monitoring do you need for statins?
If AST goes up x3 from baseline and persists. Stop the statin and restart at a lower dose if
symptoms resolve - answerAn AST rise of what ...
MRCP - Pharmacology Part 1 (Toxicity).
Exam Questions With Correct Answers
LFTs at baseline, 3 mo and 12 mo - answer✔What monitoring do you need for statins?
If AST goes up x3 from baseline and persists. Stop the statin and restart at a lower dose if
symptoms resolve - answer✔An AST rise of what level is enough to discontinue a statin? What
do you do?
- U&E at start, when increasing treatment or annually
- Rise in creatinine up to 30%, and K+ up to 5.5mol is allowed - answer✔What monitoring do
you need for ACE-I? What is an acceptable change in function?
- TFTs, U&E, LFTs and CXR prior to treatment
- TFTs and LFTs at 6 months - answer✔What monitoring do you need for amiodarone? (4/2)
Continue it if required and add levothyroxine - answer✔What happens if amiodarone causes
hypothyroidism?
- AIT1 = excess iodine causes a goitre and therefore tx with carbimazole
- AIT2 = destructive thyroiditis due to amiodarone = no goitre and tx with steroids -
answer✔What are the two types of amiodarone induced hyperthyroidism?
- Check LFTs, FBC & U&E before treatment, and then every two weeks for 2 months, then every
month then every 3 months - answer✔What monitoring do you need for methotrexate? (3)
Folate 5mg on a separate day - answer✔What drug needs to be given with methotrexate?
12h after the dose when starting the drug, at each dose change and at 3 months -
answer✔When does lithium level need to be taken?
0.4-0.8 - answer✔What is a normal lithium level?
TFTs/U&E at baseline and 6 months - answer✔Apart from lithium level, what blood tests need
to be done for monitoring lithium? (2)
LFTs - answer✔What montoring is needed for Glitazones?
CBG at baseline and regular intervals - answer✔What monitoring is needed for olanzapine?
Calcium levels at 1 month and vitamin D
- if Vit D >50 = okay
- if Vit D25-50 = deficient for some of the population
- if Vit D <25 = deficient - answer✔What monitoring is needed for vitamin D?
- Check TFTs in 6-8 weeks
- Check yearly if on maintenance dose - answer✔What monitoring, and when, is needed for
levothyroxine?
FBC = risk of agranulocytosis - answer✔What monitoring is needed for carbimazole or
clozapine?
Concentration dependant killing
- Check peak level 1h after the 3rd dose and trough level before next dose
- Peak level should be 3-5
- Trough level should be <1
As concentration dependant killing, ;need to alter the time between each dose if trough level is
raised BUT need to lower dose if the peak level is high
C/G like DNA base pairs - answer✔When do you need to check the dose of Gentamicin? What
time of killing does it have? How do you alter the dose
Check BP before starting - answer✔What monitoring is required for the COCP?
Check trough level immediately before dose - answer✔What monitoring is required for
ciclosporin?
TPMT - answer✔What test is needed before starting Azathioprine?
Check trough level immediately before dose if:
- Adjustment of dose
- Non-Adherence to medication - answer✔What monitoring is required for phenytoin?
Time dependant killing
- Check U&E before prescribing
- Change concentration if trough level is wrong - answer✔What type of killing does vancomycin
undergo? When do you need to check the dose? How do you change it?
1. HR whilst on the drug
2. U&E as renal excreted
3. Dose level at least 6h after most recent dose if suspecting toxicity - answer✔What
monitoring is required for digoxin? (3)
I've a date at 6 (digoxin 6h), so ill be late at 12 (lithium at 12h),
Call before you go (ciclo/gent as trough just before), and phone just before if in doubt
(phenytoin just before if worried about toxicity)
Check your bike just before you ciclo off - answer✔What is the pneumonic for remembering
when to check drug levels?
- No solids/non-clear fluids 6h before
- No clear fluids 2h before: allow routine medications with this - answer✔What are the rules
regarding food in surgery?
Omit on the day of surgery as risk of post-op hypotension - answer✔When do ACE-I need to be
omitted for surgery?
7 days before surgery - answer✔When do antiplatelets need to be stopped for surgery?
- Stop 4-5 days before; bridge onto LMWH.
- Stop this 24h before surgery - answer✔What are the rules regarding Warfarin and surgery?
- Stop 24h before surgery, and start 48/72h after surgery - answer✔What are the rules with
DOACs before surgery?
ONLY when there is a high risk of post-op DVT e.g. major surgery or lower limb surgery
Stop 4 weeks before surgery and start again 2 weeks after - offer POP instead - answer✔When
does COCP need to be stopped for surgery?
- Reduce long acting insulin by 20% on the day of surgery
- If twice daily mixed dose, stop these and prescribe variable rate insulin infusion -
answer✔How do you manage insulin over surgery?
2 weeks before - answer✔When must MAOIs be stopped before surgery?
Gliclazides
Metformin only if eGFR<60 - answer✔Which anti-diabetic medication needs to be omitted on
the day of surgery? (2)
DO NOT OMIT
- give 100mg hydrocortisone if major surgery extra
- give normal dose if minor surgery - answer✔What are the rules of steroids in surgery?
Omit on the day of surgery and give 24h later if U&E okay - answer✔What are the rules for
lithium and surgery?
Aminophylline
Olanzapine
This is because smoking induces cp450 and therefore REDUCES levels of aminophylline - when
you stop it increases - answer✔Stopping smoking increases the level of which two types of
drug?
- Verapamil/Beta blockers - answer✔Which two drugs interact to cause heart block?
NSAIDS + SSRIs - answer✔Which two drugs interact to cause a GI bleed?
Inducers = decrease effect of warfarin = BS CRAP GPS
- Barbiturates
- St John's wart
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