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ΩΩ 4 Bateman - PSA + Pharmacology > 3 Managing the Risk of Prescribing > Flashcards

3 Managing the Risk of Prescribing Flashcards

1
Q

What is Diltiazem?

A

Calcium channel blocker

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2
Q

Which calcium channel blocker interacts with simvastatin?

A

Diltiazem

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3
Q

How would you manage rhabdomyolysis in statin

A
  1. Stop statin
  2. Renal failure - dialysis
  3. IV fluids - prevent renal failure
  4. Sodium bicarbonate - alkalinize urine
  5. Monitr serum potassium
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4
Q

What is the definition of an adverse drug reaction?

A

Use of a medicial product within the term of the marketing authorisation as well as from use outside the terms of the marketing authorisation, including overdose, miuse, abuse and medication errors, and suspected adverse reactions associated with occupational exposure

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5
Q

What is an adverse event and adverse drug reaction?

A

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

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

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6
Q

What is a type A drug reaction?

What are some examples?

A

Type A (augmented) reactions are ones that are generally:

  1. Dose-related
  2. Common, predictable
  3. Related to the pharmacology
  4. Unlikely to be fatal

Digoxin toxicity or constipation with opioid analgesics

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7
Q

What is a type B drug reaction?

What are some examples?

A

Type B (bizarre) reactions are generally:

  1. Not dose-related (within the therapeutic dose range)
  2. Uncommon, unpredictable
  3. Not related to the pharmacology
  4. Often fatal

Penicillin hypersensitivity, and malignant hyperthermia and hepatitis caused by anaesthetic agents

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8
Q

What is type C drug reaction?

What are some examples?

A

Type C - Chronic

  1. Uncommon
  2. Related to cumulative dose
  3. Time-related

Suppression to the hypothalamic pituitary adrenal axis with long-term cotricosteroids

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9
Q

What is a type D drug reaction?

What are some examples?

A

Type D - Delayed

  1. Uncommon
  2. Usually dose-related
  3. Occurs or becomes apparent some time after use of the drug

Carcinogenesis

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10
Q

What is a type E drug reaction?

What is an example of this?

A

Type E - End of treatment

  1. Uncommon
  2. Occurs son after withdrawal of the drug

Opiate withdrawal syndrome

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11
Q

What is type F drug reaction?

What are some examples?

A

Type F - Failure

  1. Common
  2. Dose-related
  3. Often caused by drug interactions

Failure of the oral contraceptive in the presence of an enzyme inducer

Failure of therapeutic effect in patients taking anticoagulants leading to stroke

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12
Q

What does DoTS stand for?

What can ARDS be divided into due to DoTS?

A
  1. Dose
  2. Timing
  3. Susceptability
  4. Hypersusceptability reactions
  5. Collateral effects
  6. Toxic effects
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13
Q

What can ARDS be seperated into?

A
  1. Time dependent
  2. Time independent
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14
Q

What factors make you susceptable to an ADR?

A
  1. Immunological reactions
  2. Genetics
  3. Age
  4. Sex
  5. Physiology
  6. Exogenous
  7. Disease states affecting the patient
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15
Q

What diseases increase the risk of ADRs?

A
  1. Congestive cardiac failure
  2. Diabetes mellitus
  3. Chronic pulmonary disease
  4. Rheumatological and malignant disease
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16
Q

What coniditons happen more in females?

A
  1. Psychiatric adverse effects with the anti-malarial mefloquine
  2. Drug-induced torsade de pointes, linked to ventricular fibrillation and death. Women have an intrinsically longer QT interval than men
  3. Hyponatraemia with diuretics
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17
Q

What ethnic factors influence ADRs?

A
  1. Europeans metabolise warfarin differently
  2. Afro-carribeans have an increased risk of angioedema with the use of ACE inhibitors
  3. Chinese and Japanese origin are less likely to suffer psychiatric adverse effects from mefloquine
  4. Rosuvastatin altered in patinets of Asian origin, which may increase their risk of myopathy
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18
Q

What drugs increase the risk and severity of haemolysis with G6PD?

A
  1. Anti-malarials (primaquine)
  2. Nitrofurantoin
  3. Quinolone antimicrobials (ciprofloxacin)
  4. Rasburicase
  5. Sulphonamides (co-trimoxazole)
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19
Q

What is a main side effect of Clozapine?

A

Agranulocytosis

Monitor white blood cells

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20
Q

What does the yellow card shceme collect data on>

A

Both licensed and unlicensed medicines including:

  1. Prescription medicines
  2. Vaccines
  3. Over-the-counter medicines
  4. Herbal remedies
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21
Q

What percentage of the population to VERY COMMON ADRs occur in?

A

10%

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22
Q

What percentage of the population to COMMON ADRs occur in?

A

More than 1% but less than 10% of patients

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23
Q

What percentage of the population to UNCOMMON ADRs occur in?

A

more than 0.1% but less than 1% of patients

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24
Q

What percentage of the population to RARE ADRs occur in?

A

More than 0.01% but less than 0.1% of patients

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25
Q

What is the interaction between warfarin and miconazole?

A
  1. Miconazole inhibits a cytochrome P450 enzyme.
  2. This enzyme metabolises warfarin.
  3. Therefore more warfarin
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26
Q

Who elimates drugs more rapidly from their body female or males?

A

Females

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27
Q

What adverse effect are females more at risk of?

A

Torsades des points and some severe idiosyncratic (no kown cause) drug reactions

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28
Q

In which ethnic group is clopidogrel much less likely to be cleared?

A

Chinese/Japanese/Korean ancestry

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29
Q

What drugs can alcohol interact with?

A
  1. Warfarin
  2. Metronidazole
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30
Q

What syndrome can amfetamines lead to?

A

Seotonin syndrome

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31
Q

What happens in a pharmacodynamic interaction?

A

Drugs amplify or negate each other’s pharmacological effects

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32
Q

What are pharmacokinetic interactions?

A

When one drug, dietary or herbal chemical, impacts on the biotransformation of a drug, or even their distribution within the body

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33
Q

What is an example of two drugs that cause a pharmacodynamic interaction?

A

Sildenafil and glyceryl trinitrate

Severe hypotension or MI

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34
Q

What foods interact with Warfarin?

A

Leafy vegetables containing vitamin K

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35
Q

What foods can interact with ACE inhibitors?

A

If people have swapped their dietary salt for potassium-containing salt may be at risk of hyperkalaemia.

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36
Q

What drugs does grapefruit juice interact with?

A
  1. Calcium-channel blockers
  2. Statins
  3. Immunosuppressants
  4. Anti-arrhythmics
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37
Q

What kind of reaction is aminoglycoside and loop diuretic?

A
  1. Pharacodynamic interaction
  2. Both cause ototoxicity
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38
Q

What type of reaction is lithium salts and ramipril?

A
  1. Pharmacokinetic interaction
  2. ACE inhibitors reduce the GFR and increase sodium loss, which is linked with their promotion of lithium retention.
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39
Q

What is the interaction of rifampicin and the combined oral contraceptive?

A
  1. Pharmacokinetic interaction
  2. Rifampicin induces drug metabolising enzymes in the liver, cytochrome P450
  3. This reduces the effectiveness of both oestrogens and progestogens.
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40
Q

What is the reaction between verapamil and beta-blockers?

A
  1. Pharmacodynamic interaction
  2. They both have similar pharmacological effects, additive effects
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41
Q

What is the interaction between warfarin and NSAIDs?

A
  1. Pharmacodynamic interaction
  2. NSAIDS inhbit COX-1 and therefore production of protective prostaglandins.
  3. This increases the risk of bleeding
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42
Q

What is the interaction between warfarin and some macrolide antibacterials?

A
  1. Pharmacokinetic interaction
  2. Warfarin is metabolised by CYP3A4, so a reduction in CYP3A4 activity can reduce the metabolism of warfarin and therefore increase its concentration
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43
Q

When giving emergency contraception i.e levonorgestrel, what dose should be given in a woman taking carbamazepine?

A

Double the dose as any cytochrome P450 induces reduce the concentration of progestogens.

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44
Q

What drugs use organic anion-transporting polypeptides (OATPs) to enter cells?

A

Atorvastatin and fexofenadine

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45
Q

What drugs inhibit OATPs?

How does this effect atorvastatin?

A
  1. Rifampicin

Means atorvastatin does not enter first pass motabolism and increases its concentration

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46
Q

Which drugs are CYP inducers?

A
  1. Rifampicin
  2. St John’s Wort
  3. First gen anticonvulsants (phenytoin, carbamazepine and phenobarbital)
  4. Smoking
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47
Q

Which drugs are CYP inhibitors?

A
  1. Antigungals e.g. fluconazole, voriconazole
  2. Erythromycin
  3. Grapefruit juice
  4. Cranberry juice
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48
Q

What does garlic do?

A

Inhibits platelet aggregation

Caution with anticoagulants

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49
Q

What does Ginseng cause?

A
  1. Hypoglycaemic activity
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50
Q

What does Glucosamine interact with?

A

Warfarin

Increase INR

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51
Q

What does St John’s Wort interact with?

A
  1. Antidepressants - increase
  2. Warfarin - reduction in INR
  3. Oestrogen and progestogen - reduces contraceptive cover
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52
Q

What can liquorice cause?

A
  1. Hyperkalaemia - increase risk of digoxin toxicity
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53
Q

What does the concurrent use of methotrexate and folic acid do?

A

Reduce the adverse effects of therapy

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54
Q

What does oral iron do to the absorption of ciproflixacin?

A
  1. Redcues their absorption (all oral quinolone antibacterials)
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55
Q

WHAT IS ERROR THROUGH LACK OF KNOWLEDGE CALLED?

56
Q

What is an error through forgetfullness called?

A

Lapse or ‘fumbles’ (slips)

57
Q

Which unit of measurement should always be written out in full?

58
Q

What can medication errors be classed as?

A
  1. Prescribing errors
  2. Dispensing errors
  3. Preparation errors
  4. Administration errors
  5. Monitoring errors
59
Q

What are the two types of human error?

A
  1. Mistakes
  2. Skill-based errors
60
Q

What is an error of mistake?

A

Error in planning actions

61
Q

What is an error of skill-based error (slips and lapses)?

A

Error in executing correctly planned actions

62
Q

What can mistakes be divided into?

A

Knowledge-based and rule-based

63
Q

What can skill-based error be divided into?

A

Action-based errors and memory-based errors

64
Q

What are some examples of human error?

65
Q

What is an active failure?

What are some examples?

A

When we do unsafe acts or omissions that are as a result of error or violations, these are termed active failures.

  • Confusing similar sounding drug names (e.g. prescribing clotrimazole instead or co-trimoxazole)
  • Intending to prescribe a dose of 100mg but writing 200mg instead
66
Q

What are latent conditions?

Examples?

A

Provide eroor-producing conditions in which unsafe acts occure and can create long-lasting holes or weaknesses in the defences.

  • Workload
  • Staffing levels
  • Lack of training or supervision
  • Com,munication problems between healthcare dtaff
67
Q

What are the different classes of recalls?

A
  1. Class one - requires immediatr action including out of hours.
  2. Class two - requires the recall to be actioned within 48 hours.
  3. Class three - requires the recall tobe actioned within five days
  4. Class four - requires caution to be exercised when using the medicine.
68
Q

What are some ‘high-risk’ medications?

A
  1. Adrenaline
  2. Amiodarone
  3. Antipsychotics
  4. Antimicrobials
  5. Benzodiazepines
  6. Direct oral anticoaudulants
  7. Insulins
  8. LMWH
  9. Methotrexate
  10. NSAIDs
  11. Opoids
  12. Phyenytoin
  13. Potassium
  14. Warfarin
69
Q

What are the seven deadly sins of prescribing?

A
  1. Not knowing your drug
  2. Not knowing your patinet
  3. Failing to take an accurate drug history
  4. Writing an illegiable prescription
  5. Using inappropriate abbreviations, decimals, and leading zeros
  6. Failing to calculate and check drug doses accurately
  7. Failing to give clear instructions and using inappropriate verbal orders
70
Q

What does erythromycin do to warfarin?

A

Enhances warfarin’s effect

71
Q

How often should ciprofloxacin be prescribed?

A

Twice a day

72
Q

What does iron do to quinolone antimicrobials?

A

Reduced absorption

73
Q

What important compound does Tazocin contain?

A

Penicillin

74
Q

What route is enoxaprin administered?

75
Q

What do you have to take into account when prescribing digoxin?

76
Q

How often should you check TFTs when chaning levothyroxine?

77
Q

How often should patients be monitored on a maintenance dose of levothyroxine?

78
Q

What monitoring is required on Amiodarone?

A
  1. TFTs before treatment and every 6 months thereafer
  2. Amiodarone is associated with hyperthyroidism and hypothyroidism
  3. Amiodarone can also cuase pulmonary fibrosis
    Chest x-ray should be done prior to starting
79
Q

What monitoring is required on the combined oral contraceptive pill?

A
  1. Blood pressure
  2. Every 6 months
80
Q

What monitoring is done with Digoxin?

A
  1. Heart rate
81
Q

What monitoring is done with Gentamicin?

A
  1. Plasma concentration
82
Q

What monitoring is done with Methotrexate?

A
  1. Full Blood Counts
  2. Every two weeks for two months, monthly for four months and then three monthly thereafter
83
Q

What are the adult at risk gorups for vitamin D deficiency?

A
  1. Aged 65 and older
  2. Little or no exposure to sunlight e.g. care home resident, wear clothes that cover most of skin
  3. Those of African, AFrican-Carribean and south Asian origin
84
Q

What compound is best measured for vitamin D status?

A

plasma 25-hydroxyvitamin D

85
Q

Below what number is a deficiency in vitamin D?

A
  1. <25 nmol/litre
  2. 25-50 nmol/litre is deficient for some of the population
  3. >50 nmol/litre is sufficient for most of the population
86
Q

What are thr signs of vitmain D toxicity?

A
  1. Hypercalcaemia
  2. Confusion
  3. Deshydration
  4. Muscle weakness
  5. Vomiting
  6. Loss of appetite
87
Q

What should be checked before comencing therapy with adalimumab?

A

Evaluated for both active and inactive TB infection

88
Q

Who is more susceptable from lupus-like syndrome in methyldopa?

89
Q

Who are more at risk of hyponatraemia from fluoxetine?

A

Older adults

90
Q

What are examples of drugs that change electrolyte concentrations?

91
Q

What substance is normally monitored for patients at risk of bleeding?

A

Anti-factor Xa

92
Q

What antibitoic required therapeutic drug monitoring?

A
  1. IV vancomycin 1g twice a day
  2. Oral is not significantly absorbed
93
Q

What drugs cause Steven-Johnson syndrome?

A
  1. Penicillin
  2. Sulphonamides
  3. Lamotrigine, carbamazepine, phenytoin
  4. Allopurinol
  5. NSAIDs
  6. Oral contraceptive pill
94
Q

What long term problems arise from Trimethoprim?

A
  1. Fever
  2. Sore throat
  3. Rash
  4. Mouth ulcers
  5. Purpura
  6. Bruising or bleeding
95
Q

What monitoring is needed after administering iron dextran?

A
  1. Monitored for adverse effects for at least 30 minutes following each iron dextran infusion
96
Q

WHAT DRUGS CAUSE HYPOKALAEMIA?

A
  1. Excessive use of laxatives
  2. Glucocorticoid therapy
  3. Insulin
  4. Loop diuretics (e.g. furosemide)
  5. Salbutamol
  6. Antibacterials (e.g. gentamicin, amphotericin)
  7. Thiazide diuretics (e.g. bendroflumethiazide)
  8. Theophylline
97
Q

What is the maximum concentration of potassium chloride given via the peripheral route?

A

40 mmol/litre

98
Q

At what rate should potassium be given?

What is the exception to this rule?

A

10 mmol/hour

20 mmol/hour in emergency situations

99
Q

What are some common drugs that cause hyperkalaemia?

A
  1. ACE inhibitors
  2. Acute digoxin overdose
  3. Angiotension-II receptor blocker
  4. Herpain and LMWH
  5. NSAIDs
  6. Penicillins
  7. Potassium sparing diuretics
  8. Trimethorpim
100
Q

What do you give to manage hyperkalaemia?

A
  1. Protect the heart
    10 ml of calcium gluconate 10% solution, by slow IV injection over 3-5 minutes
  2. Reduce serum-potassium concentration
    IV injection of 5-10 units soluble insulin with 50 ml glucose 50% given over 5-15 minutes
    Salbutamol inhaler
  3. Rid of the body excess potassium
    Oral calcium resonium
101
Q

What is an example of a short-acting insulin?

102
Q

What are examples of intermediate-acting insulin?

A
  1. Isophane insulin
  2. Insulatard
103
Q

What are some examples of long-acting insulin?

A
  1. Insulin glargine
  2. Lantus
104
Q

What concentration can you get insulin formulations?

A
  1. 100 units/ml
  2. 200 units/ml
  3. 300 units/ml
  4. 500 units/ml
105
Q

What targets should you expect before and after meals for blood glucose?

A
  1. Before meals
    Between 4 and 7 mmol/litre
  2. After meals
    Less than 9 mmol/litre
106
Q

What are examples of aminoglycoside antibacterials?

A
  1. Amikacin
  2. Gentamicin
  3. Neomycin
  4. Streptomycin
  5. Tobramycin
107
Q

How are aminoglycosides administred?

A
  1. Normally parenterally
  2. IV or sometimes IM
108
Q

When should gentamicin levels be checked?

A
  1. 6-14 hours after the first infusion
109
Q

What affects the toxicity of gentamicin?

A

Renal dysfunction

110
Q

In what conditions is a multiple daily dosing considered for IV gentamicin?

A
  1. Ascites
  2. Children
  3. Cysticd fibrosis
  4. Endocarditis
  5. Extensive burns
  6. Pregnancy
111
Q
  1. What is the dose for gentamicin?
  2. How fast should it be administred?
A
  1. 5-7 mg/kg/day
  2. Over 60 minutes
112
Q

What are the two types of monitoring for gentamicin?

What dose is each for?

What is the way to monitor single dose gentamicin levels and what level should you aim for?

A
  1. The Hartford Nomogram - 7 mg/kg/day
  2. Urban and Craig Nomogram - 5 mg/kg/day
  3. Measure trough pre-dose, before the second infusion (document the time)
    Aim for less than 1 mg/litre
113
Q

What do you need to monitor on a gentamicin multiple daily dose regimen?

A
  1. Peak and trough concentrations
  2. Peak - one hour post dose
  3. Trough - measure pre-dose
114
Q

What are the symptoms of gentamicin toxicity?

A
  1. Tinnitus
  2. Nausea and vomiting
  3. Renal dysfunction
  4. Colitis
  5. Stomatitis
  6. Blood dyscrasias
115
Q

What is bacteria does Vancomycin target?

A

Gram positive cocci

116
Q

What is Vancomycin prescribed for?

When might it be given orally?

A
  1. Septicaemia
  2. Febrile neutropenia
  3. Prophylaxid/treatment of endocarditis
  4. C. difficle infection
117
Q

What is dose adjustment dependent on in Vancomycin dosing?

A

Creatinine clearance

118
Q

What is the usual dosing of Vancomycin?

How long is it administered over?

A
  1. 1g every 12 hours
  2. 60 minutes
119
Q

What are the side effects of Vancomycin?

A
  1. Cardiac arrest
  2. Cardiogenic shock
  3. Skin disorders (including Toxic Epidermal Necrolysis and Stevens-Johnson syndrome)
  4. Red man syndrome
    managed by disconinuing infusion and administering antihistamines
120
Q

When do you measure the Vancomycin levels?

A
  1. 36-72 hours (3-6 doses)
  2. Trough - pre dose level
  3. Concenteation - 10-15 mg/litre
121
Q

WHAT CAN ERYTHROMYCIN DO TO THE ANTICOAGULANT EFFECT OF WARFARIN?

A
  1. Increase the anticoagulant effect
122
Q

What are the different colours of warfarin and what strength are they?

A
  1. 500 micrograms = white
  2. 1 mg = brown
  3. 3 mg = blue
  4. 5 mg = pink
123
Q

What dose of warfarin is required for patients with hyperthyroidism?

A
  1. LOWER doses
124
Q

What substances decrease the effect of warfarin?

What does everything else do?

A
  1. St John’s Wort
  2. Alcohol Dependance
  3. Foods rich in vitamin K (e.g. Leafy greens)
125
Q

How often should you check INR?

A
  1. Every two weeks when changing regieme
  2. Then every 12 weeks when stable
126
Q

What does digoxin do?

A
  1. It increases the force of contractility
  2. Recues conductivity in the atrioventricular node
127
Q

When is digoxin indicated?

A
  1. Heart failure
  2. Supraventricular tachycardia
128
Q

What needs to be monitored when on digoxin?

A
  1. Renal function
  2. Electrolytes
129
Q

What is the antidote to digoxin toxicity?

130
Q

When should Digoxin blood levels be checked after administration of the last dose?

When is the full effect felt?

A
  1. At least 6 hours (8-12 hours)
  2. 8-10 days
131
Q

When do you need to check Digoxin levels for toxicity?

A
  1. Only when toxicity is suspected
132
Q

What is the theraputic range of Lithium?

A

0.4 - 1 mmol/litre

133
Q

How often should Lithium be checked after administration?

A
  1. Weekly after dose change
  2. Then 3 montly when stable
134
Q

What isa the starting dose of methotrexate?

A

7.5-15 mg weekly

135
Q

What needs to be monitored on methotrexate?

A
  1. FBC - weekly then 3 months
  2. LFTs - weekly then 3 months
  3. Renal function - weekly then 3 months
  4. Chest X-ray - before starting
136
Q

What are the signs and symptoms of methotrexate toxicity?

A
  1. Lymphopenia
  2. Thrombocytopenia
  3. Pallor
  4. Nausea
  5. Vomiting
  6. GI Bleeding
  7. Dysuria/Anuria

ΩΩ 4 Bateman - PSA + Pharmacology (8 decks)

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