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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

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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

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3
Q

symptoms of Antiepileptic hypersensitivity syndrome

A

after 1-8w of exposure:

  • fever
  • rash
  • lymphadenopathy
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4
Q

signs of Antiepileptic hypersensitivity syndrome

A
  • liver dysfunction
  • haematological, renal, and pulmonary abnormalities
  • vasculitis
  • multi-organ failure
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5
Q

how should antiepileptic drugs be withdrawn

A

Reduction in dosage should be gradual

only one drug should be withdrawn at a time

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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

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7
Q

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

A

1y

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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
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9
Q

what may valporate cause in pregnancy

A

congenital malformations

neurodevelopmental disorders

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10
Q

which antiepileptics are safer to use in pregnancy

A

lamotrigine

levetiracetam

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11
Q

what can some antiepileptic drugs reduce the efficacy of

A

hormonal contraceptives

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12
Q

what minimises the risk of neonatal haemorrhage associated with antiepileptics

A

Routine injection of vitamin K at birth

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13
Q

should women breastfeed on anti-epileptics

A

yes if on monotherapy

specialist advice sort if premature birth or combination therapy

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14
Q

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

A

carbamazepine and lamotrigine

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15
Q

Digoxin

if toxicity is suspected, when should digoxin concentrations be measured

A

within 8 to 12 hours of the last dose

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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
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17
Q

Digoxin

what is the classical precipitating factor of digoxin toxicity

A

hypokalaemia!

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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

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19
Q

Digoxin

mnx of digoxin toxicity

A
  • Digibind
  • correct arrhythmias
  • monitor potassium
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20
Q

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

A

no unless problems are suspected

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21
Q

Bisphosphonates

important adverse effects

A
  • oesophagitis
  • hypophosphataemia
  • osteonecrosis of jaw
  • atypical femoral fracture
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22
Q

Bisphosphonates

CI’d in who?

A
  • severe renal impairment
  • hypocalcaemic
  • upper GI disorder
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23
Q

Bisphosphonates

absorption is reduced if taken with what?

A

calcium, antacids, iron salts

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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.

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25
Lithium monitoring: how long after giving the dose should lithium levels be checked
12 hours post dose
26
Lithium how often should it be monitored
weekly after initiation and after each dose change until conc is stable then every 3m in 1st year and 6m thereafter
27
Lithium what shold be measured before trx
renal, cardiac, and thyroid function ECG if CVD or RFs BMI, serum electrolytues, FBC
28
Lithium how often should body-weight or BMI, serum electrolytes, eGFR, and thyroid function be monitored
every 6months
29
Lithium adverse effects
- 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
Lithium toxicity features
- coarse tremor (a fine tremor is seen in therapeutic levels) - hyperreflexia - acute confusion - polyuria - seizure - coma
31
lithium toxicity mnx
- fluids | - haemodialysis
32
adverse effects of cloazapine
- agranulocytosis (1%), neutropaenia (3%) - reduced seizure threshold - constipation - myocarditis - hypersalivation
33
Clozapine How often should differential WBC be monitored?
- weekly for 18w - then fortnightly for up to 1yr - then monthly
34
Clozapine when should blood clozapine conc be monitored
- 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
Clozapine how often should blood lipids and weight be measured
every 3 months for the first year, then yearly.
36
Clozapine how often should BG be measured
fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.
37
digoxin elixir pt info
- do not dilute | - use pipette
38
what is contained in a 5ml digoxin elixir dose
- 0.25mg digoxin - 1.5g sucrose - 0.44 g ethanol - sodium
39
Benzodiazepines important adverse effects
- drowsiness, sedation and coma | - airway obstruction and death
40
Benzodiazepines caution in?
- elderly: give lower dose - respiratory impairment - neuromuscular disease - liver failure
41
Benzodiazepines which drugs may increase its effects
cytochrome P450 inhibitors (e.g. amiodarone, diltiazem, macrolides, fluconazole, protease inhibitors)
42
Benzodiazepines communication to pt
- 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
Benzodiazepines examples
diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam
44
loop diuretics common indications for loop diuretics
- acute pulmonary oedema - chronic heart failure - other oedematous states
45
indications for thiazide diuretics
relieve oedema due to chronic heart failure in lower doses, to reduce blood pressure.
46
name some thiazide diuretics
indapamide - lower BP Bendroflumethiazide - mild or moderate heart failure
47
indications for potassium-sparing diuretics
As part of combination therapy, for the treatment of hypokalaemia
48
examples of loop diuretics
furosemide, bumetanide
49
important adverse effects of loop diuretics
- dehydration - hypotension - tinnitus - hearing loss - worsen gout
50
when should oral maintenance doses be taken
in the morning to avoid nocturia
51
Bumetanide 1mg is equivalent to what furosemide
about 40 mg of furosemide.
52
name a potassium sparing diuretic
amiloride (as co-amilofruse, co-amilozide) Aldosterone antagonists (e.g. spironolactone)
53
which part of the kidney does amiloride work on
the distal convulated tubule
54
what does co-amilofruse 2.5/20 mean
2.5 mg of amiloride and 20 mg of furosemide state the dose as the number of tablets e.g 1 tablet daily
55
how do thiazides work
inhibitthe Na+/Cl− co-transporter in the distal convoluted tubule of the nephron
56
Important adverse effects of thiazides
``` hyponatraemia hypokalaemia impotence cardiac arrhythmias precipitate acute attacks in patients with gout. ```
57
what may NSAIDs due when taken with thiazides
lower thiazide efficacy
58
SSRIs important adverse affects
- 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
SSRIs caution in prescribing ppl w/
- epilepsy - peptic ulcer disease - young ppl: self harm - hepatic impairment
60
SSRIs ECG changes
prolong QT interval
61
SSRIs should not be given with
- monoamine oxidase inhibitor - drugs that prolong the QT interval, such as antipsychotics.
62
SSRIs are oral tablets and oral drops the same dose
no 20 mg citalopram tablet is equivalent to 16 mg citalopram in 4 oral drops
63
SSRIs what is the minimum length they should take SSRIs for
at least 6 months after they feel better to stop the depression from coming back (2 years for recurrent depression)
64
SSRIs communication to pt
do not stop them suddenly
65
SSRIs monitoring
- 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
monitoring safety of OCP
- 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
indications for theophylline
- chronic asthma - Reversible airways obstruction - Severe acute asthma - Chronic asthma
68
theophylline monitoring
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)

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