6. Safe drug use Flashcards
duloxetine
SNRI
Metformin
Diabetes
Types of insulin
Novorapid insulin
Abasaglar insulin
Omeprazole
PPI
nebivolol
beta blocker
isosorbide mononitrate
nitrate, vasodilator
Furosemide
antidiuretic
Simvastatin
statin
Beclomethasone
synthetic corticosteroid
co-codamol
opioid analgesic
gabapentin
neuropathic analgesic
GABA inhibitor
mycophenolate mofetil
anti-inflammatory
reversible inhibitor of inosine monophosphate dehydrogenase
prenisolone
glucocorticoid
codeine phosphate
analgesic
Creon
Mix of lipase, protease and amylase
Hydroxocobalamin
Vitamin B12 analogue
carbamazepine
anticonvulsant
phenytoin
anticonvulsant
phenytoin
anticonvulsant
CYP450 inducers
carbamezapine
phenytoin
rifampicin
chronic alcohol
SLOW EFFECT
CYP450 inhibitors
Amiodarone ciprofloxacin erythromycin/clarithromycin metronidazole fluconazole isoniazid Acute alcohol Grapefruit juice RAPID EFFECT
isoniazid
Abx - TB
fluconazole
antifungal
Drug metabolism
Phase 1 - if prodrug activates it, if not, inactivates it or makes it toxic.
- Oxidation by CYP450
- Reduction
- hydrolysis (esterases)
phase 2 - makes it soluble by conjugating it - glucuronidation, acetylation, sulfation, methylation
Eliminated in urine or bile
aminophylline
theophylline and ethylenediamine in a 2:1 ratio. Used to treat lung conditions
What happens if you add a cytochrome p450 inhibitor to a drug metabolised by cyp450
if drug has a narrow therapeutic window e.g. warfarin, aminophylline, then there is POTENTIAL FOR AN ADVERSE DRUG INTERACTION
What is an adverse drug reaction?
any undesirable experience that happened while taking a drug that is suspected to be caused by the drug/drugs
ADR of aspirin/NSAID
GI discomfort or ulceration
Citalopram ADR
(SSRI)
hyponatraemia
Furosemide ADR
hypokalaemia
alendornic acid ADR
oesophagitis/ulceration
Aspirin ADR
Dyspepsia, haemoorhage
Bisoprolol
bradycardia, hypotension
bumetanide
(sulfamyl diuretic)
electrolyte disturbs
clarithromycin
QT interval prolongation
Co-amoxiclav
Allergic reaction
Gentamicin
Tinnitus, nephrotoxicity
Insulin
hypoglycaemia
Morphine
vomiting, resp depression
Salbutamol
Hypokalaemia, palpitations
Warfarin
haemorrhage, alopecia
Top ADR causes
NSAIDS 29.6% Diuretics - 27.3% Warfarin - 10.5% ACE 7.7% Antidepressants 7.1% Beta blockers 6.8% Opiates 6.0% Digoxin 2.9% Prednisolone 2.5% Clopidogrel 2.4% Insulin Antibiotics
What is highest priority to heck before prescribing antibiotics:
Allergy status Blood culture results Medication hx Recent antibiotic courses Renal function
Allergy status!!
Which of the following is safe to use in someone with penicillin allergy?
Amoxicillin Co-amoxiclav Doxycycline Piperacillin & tazobactam Ceftriaxone
Doxycycline (a tetracycline)
Amox, co-amox, piperacillin and tazobactam are all penicillins and cefrtiaxone is a cephalosporin (also a beta-lactam)
Comorbidities
Hepatic, cardiac, renal function
is pt pregnant or breastfeeding?
Hepatic function
how is drug handled? does it rely on hepatic metabolism?
morphine sulfate
methotrexate
Renal excreted drugs
penicillins
aminoglycosides
glycopeptides
morphine sulfate
Creatinine clearance for aminoglycosides
check eGFR
check reference guidance
