Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PSA > anti-epileptics, digoxin, bisphosphonates, lithium, cloazapine, diuretics, SSRIs, theophylline > Flashcards

anti-epileptics, digoxin, bisphosphonates, lithium, cloazapine, diuretics, SSRIs, theophylline Flashcards

1
Q

what may all antiepileptic drugs may be associated with

A

a small increased risk of suicidal thoughts and behaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which anti-epileptic drugs should be maintained on a specific manufacturer’s product (not switched between brands)

A

category 1:
Carbamazepine, phenobarbital, phenytoin, primidone

category 2:
valproate
lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

symptoms of Antiepileptic hypersensitivity syndrome

A

after 1-8w of exposure:

  • fever
  • rash
  • lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

signs of Antiepileptic hypersensitivity syndrome

A
  • liver dysfunction
  • haematological, renal, and pulmonary abnormalities
  • vasculitis
  • multi-organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how should antiepileptic drugs be withdrawn

A

Reduction in dosage should be gradual

only one drug should be withdrawn at a time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how long must pts not drive for if they have had a first unprovoked epileptic seizure or a single isolated seizure

A

6m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how long must pts be seizure free for to drive if they have established epilepsy

A

1y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Patients who have had a seizure while asleep are not permitted to drive for one year from the date of each seizure, unless?

A
  • sleep seizures occurring only ever while asleep at least 1y
  • purely asleep seizures over 3y if the patient has previously had seizures whilst awake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what may valporate cause in pregnancy

A

congenital malformations

neurodevelopmental disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

which antiepileptics are safer to use in pregnancy

A

lamotrigine

levetiracetam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what can some antiepileptic drugs reduce the efficacy of

A

hormonal contraceptives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what minimises the risk of neonatal haemorrhage associated with antiepileptics

A

Routine injection of vitamin K at birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

should women breastfeed on anti-epileptics

A

yes if on monotherapy

specialist advice sort if premature birth or combination therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are 1st line options for treating newly diagnosed focal seizures

A

carbamazepine and lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Digoxin

if toxicity is suspected, when should digoxin concentrations be measured

A

within 8 to 12 hours of the last dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Digoxin

features of digoxin toxicity

A
  • generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
  • arrhythmias (e.g. AV block, bradycardia)
  • gynaecomastia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Digoxin

what is the classical precipitating factor of digoxin toxicity

A

hypokalaemia!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Digoxin

which drugs may precipitate digoxin toxicity

A

amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin.

drugs which cause hypokalaemia e.g. thiazides and loop diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Digoxin

mnx of digoxin toxicity

A
  • Digibind
  • correct arrhythmias
  • monitor potassium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

is regular monitoring of plasma-digoxin concentration during maintenance treatment necessary

A

no unless problems are suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bisphosphonates

important adverse effects

A
  • oesophagitis
  • hypophosphataemia
  • osteonecrosis of jaw
  • atypical femoral fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Bisphosphonates

CI’d in who?

A
  • severe renal impairment
  • hypocalcaemic
  • upper GI disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bisphosphonates

absorption is reduced if taken with what?

A

calcium, antacids, iron salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bisphosphonates

how should they be taken

A

swallowed whole at least 30 min before breakfast or other
medications, taken with plenty of water.

remain
upright for 30 minutes after taking to reduce oesophageal irritation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Lithium

monitoring: how long after giving the dose should lithium levels be checked

A

12 hours post dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Lithium

how often should it be monitored

A

weekly after initiation and after each dose change until conc is stable

then every 3m in 1st year

and 6m thereafter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Lithium

what shold be measured before trx

A

renal, cardiac, and thyroid function

ECG if CVD or RFs

BMI, serum electrolytues, FBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Lithium

how often should body-weight or BMI, serum electrolytes, eGFR, and thyroid function be monitored

A

every 6months

29
Q

Lithium

adverse effects

A
  • nausea/vomiting
  • diarrhoea
  • fine tremor
  • nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
  • thyroid enlargement, may lead to hypothyroidism
  • ECG: T wave flattening/inversion
  • weight gain
  • idiopathic intracranial hypertension
  • leucocytosis
  • `hyperparathyroidism and resultant hypercalcaemia
30
Q

Lithium toxicity features

A
  • coarse tremor (a fine tremor is seen in therapeutic levels)
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
31
Q

lithium toxicity mnx

A
  • fluids

- haemodialysis

32
Q

adverse effects of cloazapine

A
  • agranulocytosis (1%), neutropaenia (3%)
  • reduced seizure threshold
  • constipation
  • myocarditis
  • hypersalivation
33
Q

Clozapine

How often should differential WBC be monitored?

A
  • weekly for 18w
  • then fortnightly for up to 1yr
  • then monthly
34
Q

Clozapine

when should blood clozapine conc be monitored

A
  • when pt stops smoking or switches to an e-cigarette
  • concomitant medicines may interact
  • pneumonia or other serious infection
  • reduced clozapine metabolism is suspected
  • toxicity is suspected.
35
Q

Clozapine

how often should blood lipids and weight be measured

A

every 3 months for the first year, then yearly.

36
Q

Clozapine

how often should BG be measured

A

fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.

37
Q

digoxin elixir pt info

A
  • do not dilute

- use pipette

38
Q

what is contained in a 5ml digoxin elixir dose

A
  • 0.25mg digoxin
  • 1.5g sucrose
  • 0.44 g ethanol
  • sodium
39
Q

Benzodiazepines

important adverse effects

A
  • drowsiness, sedation and coma

- airway obstruction and death

40
Q

Benzodiazepines

caution in?

A
  • elderly: give lower dose
  • respiratory impairment
  • neuromuscular disease
  • liver failure
41
Q

Benzodiazepines

which drugs may increase its effects

A

cytochrome P450
inhibitors (e.g. amiodarone, diltiazem, macrolides, fluconazole, protease
inhibitors)

42
Q

Benzodiazepines

communication to pt

A
  • risks of dependence, minimised by avoiding daily
    use if possible and taking them for no longer than 4 weeks
  • don’t drive or operate complex or heavy machinery after taking the drug
  • sleepiness may persist the following day
43
Q

Benzodiazepines

examples

A

diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam

44
Q

loop diuretics

common indications for loop diuretics

A
  • acute pulmonary oedema
  • chronic heart failure
  • other oedematous states
45
Q

indications for thiazide diuretics

A

relieve oedema due to chronic heart failure

in lower doses, to reduce blood pressure.

46
Q

name some thiazide diuretics

A

indapamide - lower BP

Bendroflumethiazide - mild or moderate heart failure

47
Q

indications for potassium-sparing diuretics

A

As part of combination therapy, for the treatment of hypokalaemia

48
Q

examples of loop diuretics

A

furosemide, bumetanide

49
Q

important adverse effects of loop diuretics

A
  • dehydration
  • hypotension
  • tinnitus
  • hearing loss
  • worsen gout
50
Q

when should oral maintenance doses be taken

A

in the morning to avoid nocturia

51
Q

Bumetanide 1mg is equivalent to what furosemide

A

about 40 mg of furosemide.

52
Q

name a potassium sparing diuretic

A

amiloride (as co-amilofruse, co-amilozide)

Aldosterone antagonists (e.g. spironolactone)

53
Q

which part of the kidney does amiloride work on

A

the distal convulated tubule

54
Q

what does co-amilofruse 2.5/20 mean

A

2.5 mg of amiloride and 20 mg of furosemide

state the dose as the number of tablets e.g 1 tablet daily

55
Q

how do thiazides work

A

inhibitthe Na+/Cl− co-transporter in the distal convoluted tubule of the nephron

56
Q

Important adverse effects of thiazides

A 
hyponatraemia
hypokalaemia 
impotence 
cardiac arrhythmias
precipitate acute attacks in patients with gout.
57
Q

what may NSAIDs due when taken with thiazides

A

lower thiazide efficacy

58
Q

SSRIs

important adverse affects

A
  • GI upset, appetite + weight disturbance
  • hypersensitivity reactions: skin rash
  • Hyponatraemia
  • Suicidal thoughts and behaviour
  • lowers the seizure threshold
  • increase the risk of bleeding
  • ## serotonin syndrome
59
Q

SSRIs

caution in prescribing ppl w/

A
  • epilepsy
  • peptic ulcer disease
  • young ppl: self harm
  • hepatic impairment
60
Q

SSRIs

ECG changes

A

prolong QT interval

61
Q

SSRIs

should not be given with

A
  • monoamine oxidase inhibitor
  • drugs that prolong the QT interval, such as
    antipsychotics.
62
Q

SSRIs

are oral tablets and oral drops the same dose

A

no

20 mg citalopram tablet is equivalent to 16 mg citalopram in 4 oral
drops

63
Q

SSRIs

what is the minimum length they should take SSRIs for

A

at least 6 months after they feel better to stop the depression from coming back (2 years for recurrent depression)

64
Q

SSRIs

communication to pt

A

do not stop them suddenly

65
Q

SSRIs

monitoring

A
  • Sx should be reviewed 1–2w after starting + regularly thereafter.
  • If no effect has been seen at 4 weeks, you should
    consider changing the dose or drug.

= Otherwise the dose should not be
adjusted until after 6–8 weeks of therapy

66
Q

monitoring safety of OCP

A
  • Baseline assessment: relevant history, BP, BMI
  • see again at 3m to check BP
  • Thereafter, yearly to discuss health changes and to check BP and BMI.
67
Q

indications for theophylline

A
  • chronic asthma
  • Reversible airways obstruction
  • Severe acute asthma
  • Chronic asthma
68
Q

theophylline monitoring

A

Plasma-theophylline concentration is measured 5d after starting oral treatment

and at least 3d after any dose adjustment

blood sample taken 4–6 hours after an oral dose of a modified-release preparation

PSA (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions