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ADR > ADR > Flashcards

ADR Flashcards

1
Q

What protein bound drugs are bad in hypoproteinaemia (hepatic impairment)

A

NSAIDS, Phenytoin, Warfarin, Prednisolone

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2
Q

What causes prolonged prothrombin time and high inr in hepatic impairment

A

Bleedy drugs: Warfarin, NSAIDS

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3
Q

What’s used for Vitamin K deficiency in malabsorption of fat-soluble vitamins and why? (hepatic impairment)

A

Menadiol is water soluble vitamin K, prevent increased risk of bleeding

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4
Q

What is excreted in bile and can accumulate in reduced bile excretion in hepatic impairment

A

Fusidic acid and Rifampicin

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5
Q

What drugs can impair cerebral function and precipitate a hepatic coma (hepatic encephalopathy). How to treat this?

A

Constipating drugs e.g opioids, TCAs
Sedating drugs e.g. opioids, antihistamines, benzodiazepine, Z-drugs (zoplicone, zolpidem)
Drugs that cause hypOkalaemia e.g. Loop and thiazide diuretics

TREAT: with lactulose

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6
Q

What exacerbates fluid overload (oedema and ascites) in hepatic impairment?

A

NSAIDs and corticosteroids

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7
Q

What are hepatotoxic drugs?

A

Antipsychotics, amiodarone, carbamazepine, co-amoxiclav
Fluconazole, Flucloxacillin, Isoniazid (TB), Itraconazole
Ketoconazole, Labetalol, Methotrexate,
Paracetamol, Phenothiazine, Pioglitazone (diabetes),
Rifampicin, Statins, Tetracyclines, valproate

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8
Q

Signs of liver toxicity to report

A
  1. Jaundice
  2. Abdominal pain (upper right)
  3. Nausea and vomiting
  4. Malaise (feeling unwell)
  5. Weight loss
  6. Pruritus (itching)
  7. Dark urine
  8. Pale or clay-coloured stools
  9. Drowsiness, confusion

LAB: raised liver enzymes

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9
Q

What are enzyme inhibitors?

A

SICKFACES.COM

Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Alcohol (binge drinking), Chloramphenicol, Erythromycin, Sulphonamide, Ciprofloxacin, Omeprazole, Metronidazole

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10
Q

What are enzyme inducers

A

BS CRAP GPS

Barbiturates, St Johns Wort
Carbamazepine, Rifampicin, Alcohol (chronic), Phenytoin
Griseofulvin, Phenobarbital, Sulfonylureas

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11
Q

Which drugs interact with grapefruit juice?

Hint: CVS, CNS, Immunosuppressants, Other drugs

A

CVS: Amiodarone, Dronedarone, Ranolazine, Statins, Verapamil, Dihydropyridine CCBS e.g. amlodipine

CNS: Quetiapine, Sertraline

Immunosuppressants: Tacrolimus, Ciclosporin

Other drugs: Colchicine, Phosphodiesterase type 5 inhibitors e.g sildenafil

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12
Q

Liver function tests

  1. Whats raised in hepatocellular damage?
  2. Found mainly in the bile duct. Raised in obstructive jaundice (cholestatic liver disease)
  3. Pigment in bile
  4. The only low LFT for impairment - when liver unable to synthesise proteins
  5. Raised causes bleeding
A
  1. ALT (alanine aminotranferase) and AST (Aspartate aminotransferase)
  2. ALP (alkaline phosphatase) and GGT (gamma glutamyl transferase)
  3. Bilirubin
  4. Albumin
  5. Prothrombin time/INR
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13
Q

What can renal impairment lead to?

A

Increased sensitivity, some drugs less effective, poorly tolerated side effects, plasma half-life prolonged (may need loading dose), highly sus to nephrotoxic drugs

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14
Q

What drugs are nephrotoxic?

A

ACEi, Aciclovir, Aminoglycosides (gentamicin), Aminosalicyclates, Amphoteracin B
Ciclosporin, Cephalosporins, Cyclophosphamide,
Lithium, Methotrexate, NSAIDS
Quinolones (ciprofloxacin), Tacrolimus, Tetracyclines, Vancomycin

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15
Q

Signs of Acute Kidney Injury

A
  1. Reduced urine output
  2. Fluid retention : swelling of ankles
  3. Dehydration
  4. Nausea and Vomiting
  5. Fatigue
  6. High blood pressure
  7. Confusion
  8. Slight backache

LAB RESULTS: reduced eGFR & creatinine clearance and high serum creatine

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16
Q

Dehydration is a significant risk factor for AKI. What are sick day rules? Which meds should be avoided? When to restart?

A

DAMN : Diuretics, ACEi/ARB (nephrotoxic and reduces eGFR), Metformin (increased risk of lactic acidoses in renal impairment), NSAIDs (nephrotoxic and reduces eGFR, sodium and water retention)

Sick day rules: Stop these meds if vomiting or diarrhoea (unless only minor), Fevers, sweats and shaking

Restart when well; 24-48 hours after normal eating and drinking

17
Q

Whats the cockcroft-gault formula?

A

(140-Age) x Weight (kg) x Constant /// Serum Creatinine

Women 1.04, Men 1.23

18
Q

What drugs colour urine/bodily secretions red?

A 
Dantron (e.g. Co-danthrusate - Co-danthrusate is a combination of dantron and docusate. Dantron is a mild peristaltic stimulant)
Doxorubicin
Levodopa (dark red body secretions)
19
Q

What colours urine/bodily secretions red-orange?

A

Rifampicin (body secretions)

20
Q

What colours urine/bodily secretions orange?

A

Sulfasalazine (body secretions)

21
Q

What colours urine/bodily secretions yellow-brown?

A

Nitrofurantoin

Senna

22
Q

What colours urine/bodily secretions pink-orange?

A

Phenindione is an anticoagulant which functions as a Vitamin K antagonist. Phenindione was introduced in the early 1950s. It acts similar to warfarin, but it has been associated with hypersensitivity reactions, so it is rarely used and warfarin is preferred

23
Q

What colours urine/bodily secretions blue?

A

Triamterene - Triamterene is a potassium-sparing diuretic often used in combination with thiazide diuretics for the treatment of high blood pressure or swelling. The combination with hydrochlorothiazide, is known as hydrochlorothiazide/triamterene

24
Q

What colours stools black/tarry?

A

Iron

Bismuth (black, tarry stools and tongue)

25
Q

What colours iris brown?

A

Prostaglandin analogues e.g. Latanoprost eye drops

ADR (2 decks)

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