all drugs from MCQ list Flashcards
which drugs are contraindicated in auditory disorders?
gentamycin
zoledronic acid: osteonecrosis of the jaw
what interaction would amiodarone and an -ivir drug have?
a) severe bradycardia and heart block
b) reduced eGFR
c) QT-prolongation
d) AKI
e) hypermagnesemia
f) HF
g) Blood disorders
h) visual disturbances
severe bradycardia and heart block
which drugs can cause visual disturbances
infliximab, pioglitazone and hydrocortisone
which drug must you screen for TB before use
infliximab
accidental card oops
hi x
which drug can transiently raise LFTs?
sodium valproate
what would be the most likely ADR for ceftazidime and gentamycin?
gentamycin- nephrotoxicity
reduce eGFR: AKI risk
which drugs can cause skin reactions
gentamycin
omeprazole
which drugs should NOT be given in renal impairment
furosemide metformin (LA risk) if <30 zoledronic acid if eGFR<30 parecoxib- avoid or use lowest dose/ time/ frequency ceftazidime gentamycin
what do the drugs zoledronic acid
sodium valproate have in common?
cannot be given in children of child bearing potential
monitoring requirements of: gentamycin (IV as well)
electrolytes renal before and during auditory and vestibular function measure peaks and troughs if IV concentration after 3-4 doses in children
monitoring requirements of: sodium valproate
LFTs- transient normally but monitor for 6m
FBC to ensure no bleeding risk
blood disorders
pancreatitis
monitoring requirements of hydrocortisone
height and weight in children
monitoring in amiodarone (IV as well)
LFTs before and every 6 months
potassium levels before
CRX before
thyroid before and every 6 months
IV: ECG and ensure resuscitation facilities.
liver transaminases closely
monitoring in salbutamol
potassium levels (risk of hypokalaemia) and blood glucose if they have diabetes
monitoring requirements of parecoxib
if renal impairment then monitor function and potassium/ water retention
which drug must you monitor magnesium with? especially when….
omeprazole
if used with other drugs causing hypermagnesemia e.g. digoxin
what is the likely interation between digoxin and omeprazole
a) severe bradycardia and heart block
b) reduced eGFR
c) QT-prolongation
d) AKI
e) hypermagnesemia
f) HF
g) Blood disorders
h) visual disturbances
hypermagnesemia
monitoring requirements for metformin?
renal function before and annually thereafter (twice yearly if risk factors)
monitoring requirements for infliximab (IV also)
infection- before, during and 6m after
periodic skin exam for non-melanoma skin cancer
blood disorders: fever, sore throat, bruising and bleeding
hypersensitivity reactions
TB before and 3 monthly thereafter
IV: 1-2 hours after w resuscitation equipment
what should be done if someone has TB and infliximab must be prescribed?
treat for 2 months at least and then screen every 3 months month
pioglitazone monitoring
liver function: if nausea, vomiting, abdopain, fatigue or dark urine
report haematurea
when is the risk of hypersensitivity to infliximab highest?
first 2 infusions
if not received any for >16 weeks
which patients must pioglitazone be avoided in?
bladder cancer
uninvestigated haematuria
HF or history of HF
hepatic impairment
symptoms of hypersensitivity reaction? commonly occurs in which drug and when
infliximab, if not been given for >16 weeks
fever, chest pain, BP changes, dyspnoea, transient visual loss, pruritus
which drugs should be avoided in hepatic impairment
pioglitazone zoledronic acid furosemide parecoxib- 1/2 dose! sodium valproate
zoledronic acid monitoring requirements
renal function
liver function
what should patients look out for on zoledronic acid therapy?
hip, groin or thigh pain: atypical femoral fracture
jaw pain, discharge, non-healing sores, dental mobility - osteonecrosis of the jaw
ear pain, infections: osteonecrosis of the ear
risk factors for osteonecrosis of the ear and jaw? common with which drug
zoledronic acid
jaw: potency of drug (more common at IV doses for cancer), smoking, dental disease
ear: steroid use, chemotherapy, infections, ear operations, cotton bud use
monitoring requirements of furosemide?
electrolytes
potassium and sodium levels- can precipitate encephalopathy if liver impairment
4 severe safety considerations in ciprofloxacin use, what should you counsel for each?
1.tendon damage- can occur within 48 hours and up to 2 months after use
- aortic aneurism and dissection- look out for severe sudden abdo, chest or back pain
heart valve regurgitation - severe irreversible musculoskeletal or neurological side effects
- heart valve regurgitation: rapid onset SOB when lying down, swelling on ankles, feet, abdomen and new heart palpitations
when should ciprofloxacin be discontinued?
neuro, psychiatric, tendon or hypersensitivity reactions occur
drugs to be cautioned in HF
pioglitazone: especially when given with insulin
amiodarone
hydrocortisone
which drug interacts with dairy and mineral fortified drinks
ciprofloxacin
drugs never to be used in HF
parecoxib- NSAID
which drug can impair skill based tasks such as driving?
ciprofloxacin
what is an interaction between pioglitazone and insulin?
a) severe bradycardia and heart block
b) reduced eGFR
c) QT-prolongation
d) AKI
e) hypermagnesemia
f) HF
g) Blood disorders
h) visual disturbances
HF risk is increased, especially if risk factors (past MI, stroke etc)
which patients can hydrocortisone not be used in?
CHF, diabetes, epilepsy, diverticulitis,
viral, fungal or bacterial legions,acne
drugs which can cause agranulocytosis?
sodium valproate
infliximab
which drug should be used in caution in lupus
omeprazole- omeprazole can cause
sodium valproate
risk of using amiodarone in pregnancy?
neonatal goitre, only use if no alternative
which drugs need to be used in caution in those who are susceptible to QT prolongation
salbutamol
granisetron(n&v drug)
ciprofloxacin
which drugs should be cautioned in those at risk of cardiac events?
amiodarone- last line for arrhythmia
salbutamol
parecoxib
2 drugs which should be used in caution in mitochondrial disorders and why?
sodium valproate- higher rate of acute liver failure and liver related deaths
gentamycin- risk of deafness
which drugs need their electrolytes monitoring
furosemide- hypokalemia (careful in CVD and those being treated with cardiac glycosides), in hepatic impairment hypokalaemia can precipitate encephalopathy
amiodarone (potassium levels before)
parecoxib (sodium and water retention must be monitored= renal deterioration
omeprazole- hypermagnesaemia
granisetron: can have electrolyte disturbnaces- caution in patients with QT prolongation
most likely cause of ADE caused by granisetron and ciprofloxacin?
a) severe bradycardia and heart block
b) reduced eGFR
c) QT-prolongation
d) AKI
e) hypermagnesemia
f) HF
g) Blood disorders
h) visual disturbances
QT interval prolongation
sTF: salbutamol can be used in arrhythmias
false, it can cause arrhythmias, however can be used with caution
infliximab and sodium valproate could increase the risk of
blood disorders
infliximab and sodium valproate interaction would most likely cause:
b) reduced eGFR
c) QT-prolongation
d) AKI
e) hypermagnesemia
f) HF
g) Blood disorders
h) visual disturbances
blood disorders
gentamicin use in patients with mitochondrial disorders increases the risk of
deafness
which drug is C/I in myasthenia gravis? and why?
gentamycin- impairs neuromuscular transmission
which of the drugs must be avoided in pregnancy (highlight if they can be used but only if no alternative)
yes if no alternative:
amiodarone (risk of neonatal goitre only use if no alternative)
parecoxib- avoid unless necessary, avoid in 3rd trimester
infliximab- ensure effective contraception, only use if essential
ciprofloxacin: a single dose may be used for meningococcal meningitis (eye only if benefits outweigh the risks)
AVOID:
pioglitazone
zoledronic acid
Granisetron
which of the drugs can you not abruptly withdraw
sodium valproate
which drug can transiently cause infertility?
parecoxib (long term use of several NSAID do this but stops after treatment is stopped)
patients in which furosemide is contraindicated
hypokalaemia
hyponatraemia
hypovolaemia
hepatic impairment
which drug has a high risk of bladder cancer
pioglitazone
what can high doses or rapid IV administration of furosemide cause?
tinnitus and deafness
why must furosemide be used in caution in patients with liver impairment
can cause hypokalaemia and hyponatraemia which can precipitate encephalopathy
which drug must be stopped if dehydration occurs and why?
metformin- increased risk of AKI
which type of diuretic should be used to prevent hepatic encephalopathy
potassium sparing diuretic e.g. thiazide like
which type of diuretic should be used to prevent hepatic encephalopathy
potassium sparing diuretic e.g. thiazide like
most likely interaction between sodium valproate infliximab a) severe bradycardia and heart block b)reduced eGFR c) QT-prolongation d) AKI e)hypermagnesemia f)HF g) Blood disorders h) visual disturbances
blood disorders e.g. bruising, fever, bleeding, sore throat
interaction between pioglitazone and hydrocortisone would most likely cause?
a) severe bradycardia and heart block
b) reduced eGFR
c) QT-prolongation
d) AKI
e) hypermagnesemia
f) HF
g) Blood disorders
h) visual disturbances
visual disturbances
most likely interaction between salbutamol and infliximab
a) severe bradycardia and heart block
b) reduced eGFR
c) QT-prolongation
d) AKI
e) arrhythmia
f) hypermagnesemia
g) HF
h) Blood disorders
i) visual disturbances
arrhythmia
theophylline and quinolones interaction?
increased risk of seizures
half life of amiodarone? drug loading dose?
200mg TDS for 7 days
200mg BD for 7 days
200mg OD as maintenance
50 days half life, so need a loading dose
what should be reported if on carbimazole?
sore throat, fever, malice, bleeding, ulcers
side effects of amiodarone
Nausea and vomitting and taste disurbance
Thyroid function- Hypo and Hyperthyroidism through action of IODINE in the drug
Phototoxic skin reactions: burning sensation, erythema, slate grey skin discolouration
Pulmonary toxicity- persisitent SOB/ Cough
Tremor- peripheral neuropathy- numbness in hands and feet
Corneal microdepositis in eyes- dazzled by headlights- common SE: this is reversible once drug stopped
