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Y4 CCTs > 10 potentially life-threatening drugs > Flashcards

10 potentially life-threatening drugs Flashcards

1
Q

What’s the problem with the following combination:

Methotrexate + Trimethoprim

A

Methotrexate and trimethoprim

Problem: Both drugs block DHFR

(dihydrofolate reductase that is needed for the production of follicle acid that is needed for RNA and DNA synthesis)

Consequence: Severe bone marrow depletion

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2
Q

What’s the problem with the following combination?

Allopurinol + Azathioprine

A

Allopurinol + Azathioprine

Problem: Allopurinol inhibits xanthine oxidase (normally converts 6-mercaptopurine to thiouric acid)

6-mercaptopurine causes bone marrow supression

Consequence: severe bone marrow depression

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3
Q

Enzyme inhibitors mnemonic

A

SICKFACES.COM

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4
Q

Enzyme inducers mnemonic

A

CRAP GPs

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5
Q

What’s the problem in the combination of

Verapamil (CCB) + beta-blocker

A

Verapamil + beta-blocker

Problem: severe bradycardia as SAN and AVN is inhibited

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6
Q

What drugs and why can contribute to lithium toxicity?

A

Mechanisms of Lithium toxicity

1) Lithium is monovalent cation → similar structure to sodium

Drugs that reduce the absorption of Na+ → increase absorption of lithium (potential toxicity)

2) Drugs that decrease eGFR → reduce sodium excretion

  • thiazide diuretics
  • ACE inhibitors
  • NSAIDs
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7
Q

Potential problem with Ciprofloxacin

A

Ciprofloxacin

  • may lower seizure threshold

Consequence: grand-mal seizure

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8
Q

Potential problem with Gentamycin

A

Gentamycin is aminoglycoside → potential for acute nephrotoxicity

  • requires strict monitoring

*Gentamycin is used for gram -ve infections

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9
Q

Drugs requiring strict monitoring

A
  • aminoglycosides (e.g. Gentamycin)
  • Teicoplanin
  • Vancomycin
  • Digoxin
  • Theophylline
  • Phenytoin
  • Carbamazepine
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10
Q

What types of antibiotics (apart from Penicillins) we should avoid in a patient with penicillin allergy?

A
  • Co-amoxiclav (augmentin)
  • Tazocin (piperacillin)
  • Cephalosporins
  • Carbapenems
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11
Q

What’s wrong with the combination of TCAs + MAOi?

A

TCA + MAOi

hypertensive crisis

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12
Q

What’s the danger with Vincristine?

A

Vincristine CANNOT be given intrathecally as it’s highly neurotoxic → death

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13
Q

SEs of corticosteroids therapy

A

Mnemonic → CUSHINGOID

Cataracts

Ulcers

Skin – striae/thin/bruised

Hypertension/hyperglycaemia, Hirsutism

Infection

Necrosis (femoral head)

Glycosuria

Osteoporosis/Obesity

Immunosuppression

Diabetes

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14
Q

Mnemonic for TB drugs

A

PRIEST

Pyrazinamide

Rifampicin

Isoniazid

Ethambutol

STreptomycin

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15
Q

Mnemonic for the presentation of serotonin syndrome

A

HARM

Hyperthermia

Autonomic instability

Rigidity

Myoclonus

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16
Q

SEs of TCAs

(mnemonic)

A

TCAs - Side Effects

Thrombocytopenia

Cardiac (arrhythmia, MI, CVA)

Anticholinergic

Seizures

17
Q

Mnemonic for anticholinergic SEs

A

Anticholinergic SEs → ABCD

Anorexia

Blurry vision

Constipation/Confusion

Dry mouth

18
Q

Mnemonic for SEs of sodium valproate

A

VALPROATE

  • V - valproate
  • Appetite increase → weight gain
  • Liver failure → monitor LFT during 1st 6/12
  • Pancreatitis
  • Reversible hair loss – grows back curly
  • Oedema
  • Ataxia
  • Teratogenicity; Thromobocytopaenia
  • Encephalopathy (due to increased ammonia); Enzyme inducer
19
Q

Classes and examples of anti-arrythmics

A

Sodium (Class I)

Ia Quinidine

Ib Lidocaine

Ic Flecainide

Beta Blockers (Class II) - propranolol

Potassium (Class III) - amiodarone

Calcium (Class IV) – verapamil

20
Q

Mnemonic for contraindication to ACE inhibitors

A

‘PARK’

Pregnancy

Allergy

Renal artery stenosis

K+ increase and decrease in Na+ → decrease in BP

21
Q

Mnemonic for contraindications/cautions for beta-blockers

A

Beta Blocker C.I./Cautions

ABCDE

Asthma

Block (heart block)

COPD

Diabetes Mellitus

Electrolyte imbalance (hyperkalaemia)

22
Q

Mnemonic for contraindications for Warfarin in AF

A

C.I. to Warfarin in AF

‘AF Bleeds Horrendously’

  • Adherence poor
  • Falls history/risk
  • Bleeding/coagulation disorders
  • Hypertension
23
Q

Mnemonic for contraindications to NSAIDs

A

Contraindications to NSAIDs

BARS

Bleeding (peri-operative, coagulopathy)

Asthma (10% sensitive to NSAIDs)

Renal disease

Stomach (peptic ulcer disease/gastritis)

24
Q

Short mnemonic for enzymes inducers

A

Enzyme Inducers

‘PC BRAS’

Phenytoin

Carbamazepine

Barbiturates

Rifampicin

Alcohol (chronic)

Sulphonylureas

25
Q

Drugs that may induce nephrotoxicity by biochemical changes (3 types of changes)

A
  • Increased Potassium (K supplements, K sparing diuretics, Ispaghula husk)
  • High Sodium Content (antacids)
  • Excessive Vitamin D replacement (alphacalcidol)
26
Q

(2) types of drugs that may induce nephrotoxicity by causing pre-renal damage

A
  • NSAID → renal underperfusion (prostaglandin inhibition – afferent arteriole constriction)
  • ACE inhibitors → if already under perfusion due to renal artery stenosis

​

NB care ACEI and NSAID together → acute underperfusion and AKI

27
Q

What drugs and why can cause nephrotoxicity by post-renal damage?

A
  • Crystalluria → obstruction:
    • high dose sulphonamides*
    • acetazolamide*
    • methotrexate*
  • Urinary retention
  • -Anticholinergics eg TCAs*
  • alcohol
28
Q

Drugs causing nephrotoxicity by intra-renal damage

A
  • Hypersensitivity reactions
  • Glomerular damage → penicillamine, gold, aptopril, phenytoin, penicillins, sulphonamides and rifampicin
  • Interstitial nephritis → penicillins, cephalosporins, sulphonamides, thiazide diuretics, furosemide, NSAIDs and rifampicin)
  • Acute tubular necrosis

– direct toxicity to tubule → aminoglycosides, amphotericin and ciclopsorin

29
Q

Are cephalosporins nephrotoxic?

A

Cephalosporins:

  • older ones directly toxic
  • some 3rd generation eg cefixime - rarely nephrotoxic
30
Q

Can analgesics be nephrotoxic?

A
  • NSAIDs → AKI due to hypoperfusion and interstitial nephritis as well as analgesic nephropathy
  • Combinations of paracetamol and /or aspirin → reversible analgesic nephropathy
31
Q

What can lithium cause?

A

Lithium – nephrogenic diabetes insipidus

32
Q

Principles of prescribing in renal impairment

A
  • Avoid nephrotoxic drugs wherever possible
  • Dose adjustment for CKD – depends on stage
  • Dialysis can remove some drugs
  • Some drugs just need dose adjustment according to CKD stage. Some need precise adjustment as narrow therapeutic/side effect window
  • Total daily dose adjusted :
  • Reduce size of individual dose or
  • Increase interval between doses
33
Q

Drugs to be careful about in CKD

A
  • Antibiotics
  • H2 receptor antagonists
  • Digoxin
  • Anti convulsants
  • NSAID’s

Y4 CCTs (14 decks)

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