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
[Type here]
, 1
1
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
[Type here]
Voordelen van het kopen van samenvattingen bij Stuvia op een rij:
Verzekerd van kwaliteit door reviews
Stuvia-klanten hebben meer dan 700.000 samenvattingen beoordeeld. Zo weet je zeker dat je de beste documenten koopt!
Snel en makkelijk kopen
Je betaalt supersnel en eenmalig met iDeal, creditcard of Stuvia-tegoed voor de samenvatting. Zonder lidmaatschap.
Focus op de essentie
Samenvattingen worden geschreven voor en door anderen. Daarom zijn de samenvattingen altijd betrouwbaar en actueel. Zo kom je snel tot de kern!
Veelgestelde vragen
Wat krijg ik als ik dit document koop?
Je krijgt een PDF, die direct beschikbaar is na je aankoop. Het gekochte document is altijd, overal en oneindig toegankelijk via je profiel.
Tevredenheidsgarantie: hoe werkt dat?
Onze tevredenheidsgarantie zorgt ervoor dat je altijd een studiedocument vindt dat goed bij je past. Je vult een formulier in en onze klantenservice regelt de rest.
Van wie koop ik deze samenvatting?
Stuvia is een marktplaats, je koop dit document dus niet van ons, maar van verkoper TOPDOCTOR. Stuvia faciliteert de betaling aan de verkoper.
Zit ik meteen vast aan een abonnement?
Nee, je koopt alleen deze samenvatting voor €9,83. Je zit daarna nergens aan vast.
