BNF Flashcards
1
Q
Half black-Half white box means
A
JFC says less suitable for prescribing
2
Q
Black triangle means
A
limited experience of the use of this product and the MHRA requests that all suspected adverse reactions should be reported
Biosimilar
EMA says require additional monitoring
3
Q
NHS with strike through
A
not prescribable under NHS
4
Q
Very common side effect
A
> 1 in 10
5
Q
Common side effect
A
1 in 10 - 1 in 100
6
Q
Less common side effect
A
1 in 100 - 1 in 1000
7
Q
Rare side effect
A
1 in 1000 to 1 in 10,000
8
Q
Very rare side effect
A
9
Q
Sugar-free means
A
No fructose, glucose, sucrose
10
Q
Why do sugar-free marked products contain some sugars?
A
They do not cause dental caries
11
Q
Unlicensed in the BNF Vs Unlicensed drugs
A
Unlicensed use in the BNF is off-label use
Unlicensed drugs are unapproved drugs in the country
12
Q
CHM means
A
Commission on Human Medicines
13
Q
MHRA means
A
Medicines and Healthcare products Regulatory Agency
14
Q
Dose of Zopiclone
A
7.5mg at bedtime. 3.75mg in elderly or chronic pulmonary insufficiency
15
Q
Appendix 1 of the BNF is
A
Interactions
16
Q
Appendix 3 of the BNF is
A
Cautionary labels
17
Q
Appendix 4 of the BNF is
A
IV additives
18
Q
Appendix 5 of the BNF is
A
Wound dressings
19
Q
After the appendices there are
A
Dental Formulary
Nurse Formulary
Manufacturers
20
Q
Chlorhexadine solutions in neonates
A
Risk of burns
21
Q
Dose of Atorvastatin
A
Primary Hypercholesterolaemia/Hyperlipidaemia or Familial Hypercholesterolaemia: 10mg
Primary Prevention CVD: 20mg
Secondary prevention CVD: 80mg (MAX)
22
Q
Consequences of prescribing outside of marketing authorisation
A
Increases professional responsibility and liability
Must inform patient
23
Q
Provide an oral syringe when
A
Dose prescribed is not a multiple of 5 (
24
Q
Oral/Enteral syringes must
A
be labelled “Oral” or “Enteral” in large font size
25
Which excipients are shown in monograph
Aspartame, Gluten, Sulfites, Tartrazine, Arachis (peanut) oil, Sesame oil
26
Label is recommended to include
Keep out of sight and reach of children
| Use this medicine only on your skin (when applicable)
27
Presence of Polyoxyl Castor oil in injections shown because
Associated with severe anaphylatic reactions
28
Presence of Propylene Glycol in oral/parenteral is shown because
Interacts with Disulfiram/Metronidazole
| Adverse effects if elmination impaired - eg. renal failure in neonates/young/slow metabolisers
29
Freshly prepared must be made
No more than 24hours before its use
30
Recently prepared can be used for
4 weeks stored at 15-25deg
31
Water means
Freshly drawn drinkable from public supply
| Freshly Boiled Cooled Purified
32
NICE against SMC in Scotland
SMC wins
33
Which drugs are irritant/potent and should be handled with caution
Corticosteroids, some Antimicrobials, Phenothiazines, Cytotoxics
34
Patients MUST be warned to
Keep all meds out of REACH of children
35
Child-resistant container unless
Original Pack inadvisable to break, Pt difficulty opening, requested, none available
36
Labelling MUST include
Patient Name, Name + Address of person dispensing, Date of dispensing, Name of medicine, Directions for use, Precautions
37
Label is recommended to include
Keep out of sight and reach of children
| Use this medicine only on your skin (when applicable)
38
Can dispense prescriptions from
Doctors, Dentists from EEA and Switz except Sch 1,2,3 and unlicensed in UK.
39
Prescription requirements for EEA/Switz
Ink/indelible, dated, name patient, address prescriber, particulars, signed
40
PGD is
Patient Group Direction
41
NICE is
National Institute of Health and Care Excellence
42
t.i.d
three times daily
43
NICE against SMC in Scotland
SMC wins
44
Normal Prescription requirements
Name and address patient, signed in ink, address prescriber, particulars, date, DOB if
45
a.c
before food
46
b.d, o.d, t.d.s, q.d.s
twice, once, three, four times daily
47
o.m
every morning
48
o.n
every night
49
p.c
after food
50
p.r.n
when required
51
q.q.h
every four hours
52
stat means
immediately
53
t.i.d
three times daily
54
Caution 1
Warning: This medicine may make you sleepy
55
Caution 2
Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol
56
Caution 3
Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines
57
Caution 4
Warning: Do not drink alcohol
58
Caution 5
Do not take indigestion remedies 2 hours before or after you take this medicine
59
Caution 6
Do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
60
Caution 7
Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
61
Caution 8
Warning: Do not stop taking this medicine unless your doctor tells you to stop
62
Caution 9
Space the doses evenly throughout the day. Keep taking this medicine until the course is finished, unless you are told to stop
63
Caution 10
Warning: Read the additional information given with this medicine
64
Caution 11
Protect your skin from sunlight—even on a bright but cloudy day. Do not use sunbeds
65
Caution 12
Do not take anything containing aspirin while taking this medicine
66
Caution 13
Dissolve or mix with water before taking
67
Caution 14
This medicine may colour your urine. This is harmless
68
Caution 15
Caution: flammable. Keep your body away from fire or flames after you have put on the medicine
69
Caution 16
Dissolve the tablet under your tongue—do not swallow. Store the tablets in this bottle with the cap tightly closed. Get a new supply 8 weeks after opening
70
Caution 17
Do not take more than . . . in 24 hours
71
Caution 18
Do not take more than . . . in 24 hours. Also, do not take more than . . . in any one week
72
Caution 32
Contains aspirin. Do not take anything else containing aspirin while taking this medicine
73
Caution 21
Take with or just after food, or a meal
74
Caution 22
Take 30 to 60 minutes before food
75
Caution 24
Suck or chew this medicine
76
Caution 26
Dissolve this medicine under your tongue
77
Caution 27
Take with a full glass of water
78
Caution 28
Spread thinly on the affected skin only
79
Caution 29
Do not take more than 2 at any one time. Do not take more than 8 in 24 hours
80
Caution 30
Contains paracetamol. Do not take anything else containing paracetamol while taking this medicine. Talk to a doctor at once if you take too much of this medicine, even if you feel well
81
Caution 32
Contains aspirin. Do not take anything else containing aspirin while taking this medicine
82
On a FP10D a Dentist can prescribe
Only those meds in Dental Practitioners Formulary
83
Ordering for surgery use and Private Rx the dentist can order
Anything in any quantity
84
T/F: Dentists must contact GP if they prescribed something
False
85
Computer-issued Rx must have
1. Patients first and last name and initials, patient address, age of patients under 12 and over 60, age under 5 in years and months
2. Dr's name, address, ref no, PCT, ph no
3. English. Dose and quantity numbers, frequency words. Warnings in words.
4. Max no items/Rx. Rest space spoilt
5. Hand alterations exceptional - signed. Contraceptives with ♀sign. CD signed.
6. "Confidential" on other side. Duplicate labelled as such
86
Emergency supply by patient
1. Interview to check need, previous use, dose
2. Max 5 days for Phenobarb and Sch 1,2,3. 30 Days anything else unless Insulin/Ointment/cream/aerosol/contraceptive/AB
3. POM entry date, name, quantity, form, strength, pt name, address, nature emergency
4. Label: date, name, quantity, form, strength, pt name, pharmacy name, address, words "Emergency Supply", words "Keep out of reach of children"
87
Emergency supply for prescriber
1. Satisfactory reason
2. Give Rx in 72 hours
3. Directions of prescriber
4. No 1, 2, 3 except Phenobarb for epilepsy
5. POM entry date of supply, date on Rx, date recieved RX, name, quantity, form, strength, prescriber name, address, pt name, address
88
Schedule 1 includes
Lysergide etc which are not used medicinally. HO special license
89
Schedule 2 includes
Diamorphine, Morphine, Pethidine, Amfetamines, Sodium Oxybate, Cocaine
90
Schedule 2 need
Safe custody (not secobarbital), registers etc
91
Schedule 3 include
Barbiturates (not secobarbital), Buprenorphine, Midazolam, Temazepam, Tramadol
92
Schedule 3 need
2 years invoice, Registers, Safe custody (except phenobarb, midazolam, tramadol, pentazocine, mazindol, meprobamate, phentermine)
93
Schedule 4 (1) include
Include Benzos (not tramadol, midazolam), zaleplon, zolpidem, zopiclone
94
Schedule 4 (2) include
Androgenic and Anabolic steroids, Clenbuterol, Gonadotrophins, Somatropin
95
Schedule 4 need
No Rx requirements, no safe custody
96
Schedule 5 need
Retention 2 years
97
Prescription requirements for CDs are
Indelible, signed by hand, dated, prescribers address, pt name and address, form and strength, volume in ml or dose units/total in words and figures, dose
98
Pharmacist can amend Sch 2 or 3 scripts by
if total quantity in words/figures only or minor typographical errors
99
Pharmacist amendment must be
clearly attributable to pharmacist
100
Script validity of Schedule 2, 3, 3 is
28 days from issue date or date post-dated
101
Instalment scripts must specify
Amount of instalments, intervals to be observed
102
Regarding repeats for schedule 2 and 3
not allowed
103
Private prescriptions for schedule 2 and 3 must be
Written on designated form giving prescribers identification number unless in hospital
104
30 days treatment on Rx for
Schedule 2, 3 and 4 unless justified (add to notes)
105
Canabis extract used for
spasticity in multiple sclerosis
106
Supervised consumption when
starting (3 months), after relapse, major dose increase
| Continued until prescriber confident on compliance
107
Which drugs are not subject to import export licensing
Sch 4 (2) and 5
108
Personal import export license for carrying
Sch 2, 3, 4 (1) if travelling for more than 3 months
109
To treat addiction of Cocaine, Diamorphine and Dipipanone
need a HO license
110
To treat pain with Cocaine, Diamorphine and Dipipanone
no license needed
111
What should be reported via the Yellow Card Scheme
All suspected SERIOUS/new drug adverse drug reactions to any therapeutic agents even if due to overdose, misuse, medication error or off-label and unlicensed meds.
112
Who can report on Yellow card scheme
Healthcare professional or patient/carer
113
What is the Drug Safety Research Unit
Identifies selected patients on new meds and collects data on clinical events
114
How long does a black triangle drug remain a black triangle drug
5 years
115
Which ADR of black triangle drugs should be reported
ALL ADR
116
Examples of serious ADR
Blood disorders, Anaphylaxis, Endocrine disturbance, Effect on fertility, Haemorrhage, Renal impairment, Jaundice, Opthalmic disorder, severe skin/CNS effects, reactions in pregnant women
117
NRLS is
National reporting and learning system
| When medication error
118
Drug Safety Update is
a monthly newsletter from MHRA and CHM
119
Oral ulceration side effect of
Cytotoxics (methotrexate), ACEI, gold, nicorandil, NSAIDs, Pancreatin, Penicillamine, Proguanil, Protease inhibitors
Aspirin (left in mouth), essential oils (rarely)
120
Erythema Multiforme/Steven-Johnson syndrome side effect of
Antibacterials, Antiretrovirals, Sulfonamide derivatives, Anticonvulsants
121
Lichenoid eruptions associated with
ACEI, NSAIDs, Methyldopa, Chloroquine, Oral Antidiabetics, Thiazide diuretics, gold
122
Candidiasis side effect of
Antibacterials, immunosuppresants, corticosteroids
123
What causes brown staining of teeth
Frequent use of Chlorhexadine mouthwash, spray or gel
| remove by polishing
124
Enamel (of teeth) stained black by
Iron
125
Superficial staining of teeth by
Co-amoxiclav
126
Intrinsic yellow-grey staining of teeth caused by
Tetracyclines
127
Tetracycline contraindicated in
Pregnancy, Breast feeding,
128
Flouride ingestion can cause
Dental fluorosis with mottling of enamel
| Areas of hypoplasia/pitting
129
Osteonecrosis of jaw by
Bisphosphonates therefore dental check up
130
Gengival overgrowth by
Phenytoin, Ciclosporin, Nifidipine (CaCB)
131
Xerostomia means
reduced flow
132
Xerostomia (and dry mouth) caused by
Antimuscarinics (Anticholinergics), SSRI, TCAs, Alpha blockers, Antihistamines, Antipsychotics, Baclofen, Buprpion, Clonidine, 5HT1 agonists, opioids, tizanidine, diuretics (in excess)
133
Pain in salivary glands caused by
Antihypertensives (Clonidine, Methyldopa) and vinca alkaloids
134
Swelling of salivary glands caused by
iodides, antithyroid drugs, phenothiazines, sulfonamides
135
Taste altered by
Amiodarone, Calcitonin, ACEI, Carbimazole, Clarithromycin, gold, Griseofulvin, Lithium salts, Metformin, Metronidazole, Penicillamine, Phenindione, Propafenone, Protease inhibitors, Terbinafine, Zopiclone
136
Defective medicines reported to
Defective Medicines Report Centre
137
Adverse drug reactions in children should be reported by
Yellow Card Scheme and British Paediatric Surveillance Unit's Orange Card Scheme or NRLS
138
Neonate and infant are
First month and First year
139
If child dose greater than adult dose
Should not exceed adult dose
140
Obese child
Use IBW
141
Dose frequency consideration in children
Flexible so don't have to wake at night
142
Rifampacin and Fusidic acid excreted
Hepatically
143
Phenytoin and Prednisolone
Highly protein bound
144
Hypoalbuminaemia/proteinaemia causes
Increase in conc of drugs highly protein bound
145
What happens with anticoagulants in liver disease
Clotting factors made in liver -> conc down -> increase prothombin time -> more sensitive to anticoagulants (phenindione/warfarin)
146
Drugs that can precipitate hepatic encephalopathy
All sedative drugs, opioid analgesics, hypokalaemia causing diuretics, constipation causing drugs
147
Oedema and Ascites exacerbated by
Drugs giving rise to fluid retention like NSAIDs and Corticosteroids
148
Elderly person without raised serum creatinine
because of wasting muscle. Assume mild impairment
149
Loading does is reduced in renal impairment T/F?
False
150
Patients at extremes of weight and renail impairment
30 BMI use absolute GFR/Cr Cl (CG)
151
Tetrogenesis (Malformations) occurs during
First trimester: 3 - 11 wks
152
Growth, functional development and toxic effects on foetus
2nd and 3rd trimester
153
Drugs unsafe in breast feeding
Fluvastatin, Phenobarbital, Bromocriptine
154
Do not give oral treatment to palliative care when
Dysphagi, coma, nausea, vomiting
155
What are the three classes of analgesics
1. Non-Opioid (Para, NSAID)
2. Opioid (Codeine, Morphine)
3. Adjuvants (Anti-epileptics, Anti-depressants)
156
Pain management in palliative care
Paracetamol -> NSAIDS -> Codeine -> Tramadol -> Morphine (Burprenorphine, Fentanyl, Hydromorphone, Oxycodone, Methadone)
157
Psychological dependence with opioids not issue when
palliative care
158
Pain in bone metastases
Bisphosphonates, radiotherapy, strontium
159
Neuropathic pain management
TCA -> Antiepileptic (Pregabalin, Gabapentin)
Ketamine
Nerve compression pain: Corticosteroids (Dexamethasone)
Epidural
160
Breakthrough pain dose amount
1/10 to 1/6th of original dose
161
Review pain management if
162
Which of the following Fentanyl formulation is licensed for breakthrough pain: Nasal, Buccal, Sublingual
all
163
Opioids should be prescribed with
laxatives
164
Patient can't tolerate morphine but needs opioid
Oxycodone
165
Oral:Parenteral dose morphine
2:1
166
Transdermal morphine for
steady patients/long term
167
Palliative Anorexia give
Prednisolone 15-30mg daily
| Dexamethasone 2-4mg daily
168
Palliative Bowel Colic or excessive respiratory secretions give
Hyoscine hydrobromide 0.4mg
Hyoscine Butylbromide 20mg
Glycopyrronium 0.2mg
169
Palliative Capillary bleeding
Tranexamic acid by mouth
| Or gauze soak Tranexamic or Adrenalin - onto site
170
Palliative Bleeding with prolonged clotting in liver disease
Vitamin K
171
Palliative constipation
Faecal softner with peristaltic stimulant (co-danthmer)
Lactulose
Methylnaltrexone
172
Palliative convulsions
Prophylaxis: Phenytoin, Carbamazapine
Diazepam 10mg rectal, Phenobarbital 50-200mg bd
Midazolam IV
173
Palliative dry mouth
Chewing SF gum, suck ice, suck pineapple, artificial saliva (Aquoral, Biotene Oralbalance, AS Saliva Orthana, Xerotin, Saliveze, Salivix)
174
Palliative dysphagia
Dexamethasone 8mg daily
175
Palliative Dyspnoea
Morphine 5mg qqh
Diazepam 5-10mg daily
Dexamethasone 4-8mg daily
176
Fungating tumours
Antibacterial drugs
| Metronidazole
177
Palliative GI pain
Colic: Loperamide 2-4mg qd, Hysoscine hydrobromide (Kwells)
Distension: Antiflatulent (Simitecone), Domperidone 10mg td before meals
178
Palliative Hiccup
Antacid, Antiflatulent, Metoclopramide 10mg every 6-8 hours, Baclofen 5mg bd, Nifedipine 10mg rd, chlorpromazine
179
Palliative Insomnia
Benzodiapines, Temazepam before hypnotics
180
Intractable cough
morphine 5mg qqh
| NOT methadone
181
Palliative Nausea and Vomiting
Treat cause then anti-emetic (Haloperidol 1.5mg/5-10mg od/bd, metocloperamide 10mg td) 4-5 days
Cyclizine 50mg td
Levomepromazine 6mg or 6.25mg at bedtime - 12.5-25mg bd with dexamethasone 8-16mg
182
Palliative pruritis
Emollients
| Obstructive Jaundice: Colestyramine
183
Raised intracranial pressure
dexamenthasone 16mg for 4-5days -> 4-6mg
184
Counselling with dexamethasone
Give before 6pm to avoid insomnia
185
Palliative Restless and Confusion
Antipsychotic every 2 hour: Haloperidol 2mg oral/2.5mg SC or Levomepromazine 6mg oral/6.25mg SC
186
Parenteral route when
Patient unable to take by mouth
Malignant bowel obstruction
Patient doesn't want by mouth (occasionally)
187
Midazolam in palliative care
Flumazenil available to reverse effects
| Use high strength
188
Side effect of Levopromazine
Sedation
189
Cyclizine not given with
Diaorphine and others
190
Metoclopramide causes
Skin reactions
191
Ocreotide acts by
stimulating water, electrolyte absorption and inhbits water secretion in bowel - for vomiting due to bowel obstruction
192
SC pain relief
Diamorphine cuz can give less
193
T/F?: Injections can be mixed
False. Syringe drivers can be if compatible
194
What is contraindicated in syringe drivers
Chlorpromazine, prochlorpromazine, Diazepam
| Less: Levomepromazine, cyclizine
195
What CAN be mixed with Diamorophine
Cyclizine (low dose), Dexamethasone, Haloperidol (24hrs), Hyoscine, Levomepromezine, metoclopremazine, midazolam
196
Tablets in frail elderly cause
Mouth ulceration, oesophageal ulceration
197
Old people sensitivity increased to
Opioid analgesics, benzodiazepines, antipsychotics, antiparkinsonian drugs
Antihypertensives, NSAIDs
198
Renal clearance in elderly patients
reduces. Therefore VERY susceptible to nephrotoxic drugs
199
Narrow TI drugs in elderly
After MI/CxInf go toxic
200
Lipid soluble drugs in elderly
reduced because liver volume reduced
201
Elderly person with constipation, which drugs causative
Antimuscarinics, Tranquilisers
202
Elderly person with hypotension, which drugs causative
diuretics, psyschotropics. Causes falls
203
Elderly people side effects hypnotics
drowsiness, unsteady gait, slurred speech, confusion
| Benzodiazepines impair balance
204
Elderly people on diuretics
NOT for long term for grav oedema (raise legs, stockings, increase movement)
205
Elderly people side effects NSAIDs
serious bleeding
206
Elderly people contraindication NSAIDS
Cardiac disease, renal impairment
207
Paracetamol used first in elderly for
osteoarthritis, soft-tissue lesions, back pain, rheumatoid arthritis
208
For osteoarthritis, soft-tissue lesions, back pain, rheumatoid arthritis give
Try weight reduction, warmth, exercise, walking stick (all except RA) -> para -> low dose NSAID -> max para + low dose NSAID -> para + max NSAID or Opioid
NEVER 2 NSAIDs
209
Drugs causing ADR in elderly
antiparkisonians, antihypertensives, psychotropics, digoxin (125mcg or 62.5mcg if renal)
210
Which drugs avoided in elderly
Bone marrow suppression causing (co-trimoxazole, mianserin) as blood disorders more common
Long acting antidiabetics, glibenclamide
211
Elderly on Warfarin
lower maintenance dose
212
Dosage in elderly
50% of normal adult
213
Hypotension during dental appointment
1. Lay flat
2. Oxygen
3. Transfer to hospital urgently
214
Anaphylatic reactions can happen with
latex gloves, arachis (peanut) oil etc
215
Symptoms of Anaphylaxis
Paresthesia, flushing, sweeling of face
Itching especially hands/feet
Bronchospasm/Laryngospasm - wheezing and difficulty
Rapid Weak pulse, BP fall, pale colour, cardiac arrest
216
Management Anaphylaxis
Andrenaline 0.5mg IM
| Oxygen
217
Asthma attack in dentists
2 puffs short acting beta2 agonist (salbutamol) via spacer/bag if needed
Oxygen
with salbutamol5mg/terbutaline10mg nebuliser
If anaphylaxis: Adrenaline
218
Cardiac emergency in dentists
GTN
If MI (severe/prolonged angina) sit in position comfortable
Oxygen
Aspirin 300mg (send note)
219
MI symptoms
```
Progressive onset of severe crushing pain across front chest, pain radiate toward shoulder/down arm/neck/jaw
Skin pale/clammy
Nausea vomiting
Weak pulse, BP down
Breathlessness
```
220
Epileptic patients at dentist
continue treatment as normal
221
Epileptic seizure symptoms
Loss consciousness. ridid, falls, cry, tonic
30 seconds jerking, tongue biting
Mouth frothing, urinary incontinence
After it - flaccid, unconscious, confusion
222
Management epileptic seizure
Oxygen
After convulsion - coma position, check breathing
>5min - give Midazolam 10mg buccal
223
Hypoglycaemia symptoms
trembling, sweating, pins/needles lips/tongue, hunger, palpitation, headache, double vision, concentration difficulty, slurred speech, confusion, behaviour change, convulsions, unconsciousness
224
Management hypoglycaemia
Glucose 10-20g as sugar, Lucozade 55ml, coca cola 100ml, ribena blackcurrant 19ml (before dilution), 2 tsp sugar, 3 sugar lumps
Repeat 10-15mins
Glucagon 1mg IM
225
Syncope symptoms
Feel faint, low BP, Pale/sweating, Yawn, slow pulse, nausea vomiting, dilated pupils, muscular twitching
226
Management syncope
Lay flat, raise leg, loosen tight clothing, sweet tea/sugar in tea
227
Very Anxious patient at dentists with cardiac issues
Temazepam
228
Anticoagulant therapy at dentists
72 before INR assessed
| Minor dental
229
IM injections contraindicated in
Patients taking anticoagulants with high INR/haemostasis disorder and try to avoid in any anticoagulant
230
Anticoagulant serious interactions
Aspirin, NSAIDs, Carbamazepine, imidazole, triazole antifungals (miconazole), Erthyromycin, Clarithromycin, Metronidazole
Broad-spectrum antibiotics: ampicillin/amoxicillin
231
Need help identifying tablet/capsule
Front cover, Medicines information centre
232
What are delayed acting poisons
Aspirin, ironm paracetamol, TCA, Co-phenotrope (diphenoxylate with atropine Lamotil), MR preps
233
CO poisoning
oxygen max conc
234
CNS depressants poisoning
Hypotension: raise foot bed + IV NaCl
| vaso sympathomimetics
235
Aspirin OD
Fluid depletion no hypotension. vomiting, sweating, hyperpnoea
236
Amfetamines/Phencyclidine/Cocaine OD
Hypertension
237
Cardiac conduction/arrhythmia from
TCA/Antipsychotic/Antihistamine OD
238
Hypothermia from
Barbiturates/Phenothiazine/CNS stimulant/Antimuscanic OD
239
Severe Hyperthermia side effect of
Serotonin Syndrome
240
Treating OD side effect convulsion
Diazepam 10mg/Lorazepman 4mg
241
Should not be given IM for convulsions
Benzodiazepines
242
Give activated charcoal if the following are OD
Carbamazepine, Dapsone, Phenobarbital, Quinine, Theophylline
243
Give activated charcoal with
Antiemetic
244
Activated charcoal doesn't work with
Iron, Lithium
245
Aspirin OD
Activated Charcoal, Sodium Bicarboante (check plasma - hypokalaemia riks)
Severe: Haemodialysis
246
Symptoms of Aspirin OD
Hyperventilation, Tinitus (ringing ears), deafness, vasodilation, sweating
247
Symptoms Mefenemic Acid OD
Convulsions
248
Symptoms Ibuprofen OD
Nausea, vomiting, epigastric pain, tinnitus (ringing ears)
249
NSAID OD management
Activated charcoal
250
Symptoms Paracetamol poisoning
Nausea, vomiting (24hrs), right subcostal pain/tenderness (means hepatic necrosis)
3-4 days symptoms LD: encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, death
251
Paracetamol OD weight 140kg
Use 110kg for above 110
252
Management Paracetamol OD
Acetylecysteine (up to 8 hrs) if above treat line or 8-24hrs after high OD
High OD: Activated charcoal
253
Liver damage identified by
plasma-paracetamol conc after 4 hours
254
Plasma-paracetamol conc for times
4-15 hours
255
Enzyme inducers should be considered in paracetamol OD
No
256
Acetylcysteine dosage
3 IV infusions over 21 hours
257
Acetylcysteine caution in
Asthma, Anticoagulant
258
Opioid OD characterised by
Respiratory depression, pin point pupils, coma
259
Management Opioid OD
Nalaxone which reverses it with multiple doses (buprenorphine partial reverse)
260
Opioid OD dose not appropriate for
Opioid induced respiratory depression and sedation in palliative care/chronic opioid use
261
TCA OD symptoms
Dry mouth, coma, hypotension, hypothermia, hyerreflexia, convulsions, respiratory failure, cardiac problems, dilated pupils, urinary retension
262
management TCA OD
IV Lorazepam/Diazepam
Activated charcoal
Sodium bicarbonate
263
SSRI OD symptoms
nausea, vomiting, agitation, tremor, nystagamus, drowsiness, sinus tachycardia, convulsions
264
What is serotonin syndrome
neurophsychiatric effects, neuromuscular hyperactivity, autonomic instability, hyperthermia, rhabdomylosis, renal failure, coagulopathies (blood can't clot)
265
management SSRI OD
Activated charcoal
Lorazepam, diazepam, midazolam
Contact NPIS for serotonin syndrome
266
Antimalarial (quinine, chloroquine, hydroxychloroquine) OD symptoms
arrhythmia, convulson
| Contact NPIS
267
BB OD symptoms
lightheaded, dizzy, syncope (due to bradycardia/hypotension), heart failure exacerbation
Sotalol and Propanolol more
268
Management BB OD
Atropine IV
unresponsive -> Glucagon + glucose
or Isoprenaline
269
CaCB OD symptoms
nausea, vomiting, dizziness, agitation, confusion, coma, hyperglycaemia
Verapamil, Diltiazem: hypotension, arrythmia, heart block, asystole and cardiac depression
270
management CaCB OD
Activated Charcoal (
271
Benzodiazepine OD symptoms
drowsy, ataxia (balance), dysarthria (can't speak), nystagmus (involuntary eye), respiratory depression, coma
272
Management Benzodiazepine OD
Activated charcoal (
273
Iron OD symptoms
nausea, vomiting, abdo pain, diarrhoea, blood in vomit, rectal bleeding, hypotension, hepatocellular necrosis
Severe: coma, shock, metabolic acidosis
274
Management Iron OD
Desferroxiamine IV
| Contact NPIS
275
Lithium toxicity caused by
Dehydration, renal bad function, infection, diuretics, NSAIDs
276
Symptoms of Lithium OD
delayed (12hours)
apathy, restleness -> vomiting, diarrhoea, ataxia, weakness, dysathria (speaking problem), muscle twitching, tremor
-> convulsion, coma, hypotension
277
management lithium OD
haemodialysis, correct electrolytes, convulsion, renal problem
Severe: Gastric lavage
278
Phenothiazine OD
Hypotension, hyperthermia, cardiac problems, dystonia (give procyclidine/diazepam), convulsions
279
Second gen Antipsychotics OD
drowsy, convulsions, extrapyrimidal symptoms, hypotension, ECG problems
Activated charcoal
280
Stimulant OD symptoms
Amfetamines: wakefulness, paranoia, hallucination, hypertension, convulsion, hyperthermia, coma
Cocaine: Agitation, dilated pupils, tachycardia, hypertension, hallucination, hyperthermia, hypertonia, hyperreflexia, cardiac problem
Ecstasy: delirium, coma, convulsions, hyperthermia, renal failure, rhabdomyolysis, coagulation, hypotension, haemorrhage
281
Treatment stimulant OD
Amfetamines: tepid sponging, anticonvulsants, artificial respiration
Cocaine: IV diazepam
Ecstasy: Diazepam
282
Theophylline OD symptoms
vomiting, agitation, restlessness, dilated pupuls, tachycardia, hypergylcaemia, blood vomit, convulsions, hypokalaemia
283
management theophylline poisoning
```
activated charcoal
ondansetron
IV potassium chloride
IV lorazepam/diazepam
BB unless asthma
```
