BNF Misc Flashcards
What is a biological medicine? Give two examples
They are made by or derived from a biological source using biotechnology such as recombinant DNA technology. Size, complexity as well as the way they are produced by result in a degree of variability - this is acceptable within strict limits. E.g. Insulins & Monoclonal antibodies
TRUE OR FALSE Biological medicines must be prescribed by brand name. Brand must be specified on Rx. Can they be substituted at the point of dispensing? Applicable to biosimilar meds too
TRUE Brand name specific on Rx and no substitutions at the point of dispensing. Applicable to biosimilar meds too
What is a biosimilar medicine?
It’s a biological medicine which is highly similar and clinically equivalent to an existing biological medicine which has already been authorised by the EU. Active substance is similar but not identical. Once the patent runs out on the biological version - the biosimilar can be authorised by EMA. European Medicines Agency
Is a biosimilar the same thing as a generic medicine?
No because a biosimilar is similar not identical to the original. Whereas the generic is identical to original.
When biosimilar med has been given initial authorisation - what is it subject to? What should be recorded when reporting side effects?
Black triangle status Important to report suspected reactions using Yellow card scheme. Clearly include brand name and batch number.
Give some examples of biosimilar meds?
- Enoxaparin sodium 2. Epoetin alfa /zeta 3. Filgrastim 4. Infliximab 5. Insulin glargine/lispro
When should oral syringes be supplied? When should the 5ml spoon be used?
Supplied when oral liquid medicines are prescribed in doses OTHER THAN MULTIPLES OF 5ML. 5ml spoon us used for doses of 5ml/multiples of
Branded oral liquid preparations that do not contain 1. 2. 3. are described as ‘sugar-free’ in the BNF.
Preparations containing 4. 5. 6. 7. 8. are described as “sugar free” as evidence shows they do not cause ______.
- Fructose 2. Glucose 3. Sucrose
- Hydrogenated glucose syrup 5. Mannitol 6. Maltitol 7. Sorbitol 8. Xylitol Don’t cause dental caries.
Sugar free should be used whenever possible.
Benzyl alcohol present in some injections as a preservative has been associated with what?
Fatal toxic syndrome in preterm neonates. Should not be used.
Polyoxyl castor oil present in some injections as a vehicles is associated with ___?
Severe anaphylactoid reactions
Propylene glycol can cause adverse effects if its elimination is impaired. In which patients should be cautious? Which two medicines can it react with?
- Renal impairment 2. Neonates and Young children 3. Slow metabolism 1. Disulfiram 2. Metronidazole
Is lactulose in medicines an issue for lactulose intolerant patients?
Usually amount too small to cause problems. But if severe intolerance - amount of lactulose should be determined before prescribing.
Extemporaneous preparation - should be freshly made…what does this mean?
Must not be made more than 24 hours before it is issued.
If something has been recently prepared - what is the likely timeframe for deterioration ?
Deterioration is likely if stored for longer than about 4 weeks at 15-25 degrees.
What does water mean when it is used without qualification? When should it be used
Potable water freshly drawn direct from public supply and suitable for drinking OR Freshly boiled and cooled purified water. Latter should be used if the public supply is from storage tank or if potable water is unsuitable for a particular preparation.
The Misuse of Drugs Act 1971 has 3 classes of CDs which on the harmfulness attributable to a drug when misused.. Give examples of Class A drugs (13) When are class B substances classed as Class A?
- Alfentanil 2. Cocaine 3. Diamorphine hydrochloride (heroin) 4. 3,4 - methylenedioxymethamfetamine MDMA/Ecstasy 5. Fentanyl 6. Lysergide (LSD) 7. Morphine 8. Opium 9. Oxycodone hydrochloride 10. Pethidine hydrochloride 11. Phencyclidine 12. Remifentanil 13. Methadone hydrochloride class B when prepared for injection become class A
Give examples of Class B drugs (9)
- Oral amphetamines 2. Barbiturates 3. Cannabis 4. Sativex (cannabis) 5. Codeine phosphate 6. Dihydrocodeine tartrate 7. Ketamine 8. Nabilone 9. Pholcodine
Give examples of Class C drugs (11)
- Drugs related to ampehtamines such as benzfetamine and chlorphentermine 2. Buprenorphine 3. Most benzadiazepines 4. Tramadol hydrochlordie 5. Zopiclone 6. Zopidem 7. Androgenic and anabolic steroids 8. HCG & non-human - Human chorionic gonadotrophin 9. Somatotropin, Somatropin 10. Gabapentin 11. Pregabalin
What does the black triangle on medicines mean?
Identifies newly licensed medicines that require additional monitoring by the European Medicines Agency.
How long should black triangle usually stay on a product and what do you report according to MHRA?
Usually 5 years Report any adverse effects including those that are not considered to be serious Also even if not sure the drug caused it or if reaction is well recognised or if may have been caused by another drug Report through the Yellow Card Scheme
When should adverse effects of well established vaccines and medicines (inc. OTC/herbal/unlicensed/off-label) be reported?
Serious, medically significant or result in harm Examples - anaphylaxis, blood disorders, endocrine disturbances, fertility etc Prolonged hospitalisation, life threatening, fatal, incapacitating
What are some examples of drugs/classes hat can cause oral ulcers? (7)
- Cytotoxic drugs - methotrexate 2. ACE inhibitors 3. Gold 4. Nicorandil (used in angina) 5. NSAIDs 6. Penicillamine 7. Protease inhibitors
What drugs can stain the teeth and what colour?
- Chlorhexidine (brown) 2. Iron salts in liquid form (black) 3. Tetracyclines (intrinsic staining - permanent yellow-grey) AVOID in pregnancy/children under 12 4. Fluoride - excessive ingestion leads to mottling of enamel- white patches
Gingival overgrowth is a side effect of which 3 medicines?
- Phenytoin Sometimes… 2. Ciclosporin 3. Nifedipine
Examples of drugs that cause xerostomia (dry mouth/reduce saliva flow)? (10)
- Antimuscarinics 2. Antidepressants - tricyclic and SSRIs 3. Alpha-blockers 4. Antihistamines 5. Antipsychotics 6. Baclofen 7. Bupropion hydrochloride 8. Clonidine hydrochloride 9. Opioids 10. 5HT1 agonists
Examples of drugs that cause taste disturbance? (14)
- Amiodarone
- ACE inhibitors
- Calcitonin
- Carbimazole
- Clarithromycin
- Gold 7
- Griseofluvin
- Lithium salts
- Metformin
- Metronidazole
- Penicillamine
- Phenindione
- Terbinafine
- Zopiclone
Why are Penicillins and cephalosporins not usually given by continuous infusion? Which method instead?
Due to stability problems and because adequate plasma and tissue concentrations are best obtained by intermittent infusion
What is the New Medicines Service? and what are the 3 stages?
Provides education and support to patients who are newly prescribed a medicine to manage a long term condition 1. Patient engagement 2. Intervention 3. Follow up
Which patients are eligible for New Medicines Service?
Prescribed a new medicine for one of the following: 1. Asthma 2. COPD 3. Type 2 diabetes 4. Hypertension 5. New antiplatelet or anticoagulant
What is the Medicines Use Review?
Structured adherence-centered reviews with pts on multiple medicines esp for long term conditions. Periodically but no more than once a year
What must the pharmacist providing the MUR service ensure of?
At least 70% pts are within the two groups: 1. Pts on high risk meds - NSAIDs, anticoagulants (inc. low molecular weight heparin), antiplatelets, diuretics 2. Pts recently discharged from the hospital who have had changes made to their meds whilst in hospital
What’s the age range for a neonate and child?
0- 28 days neonate/new born infant 1 month - 17 years child
Hypoalbuminaemia in severe liver disease is associated with reduced protein binding and increased toxicity of some highly protein bound drugs such as ____ & _____?
Phenytoin Prednisolone
manufacturers advise caution with warfarin in mild to moderate hepatic impairment; avoid in severe impairment. Why?
Reduced clotting Reduced hepatic synthesis of blood-clotting factors indicated by prolonged prothrombin time, increases sensitivity to oral anticoagulants such as warfarin sodium and phenindione
Which drug types can precipitate hepatic encephalopathy (decline in brain function that occurs as a result of severe liver disease)? (4)
- All sedative drugs 2. Opioids 3. Drugs that cause constipation 4. Diuretics that produce hyPOkalaemia
Which two drug groups can cause exacerbate fluid overload (oedema & ascites) in chronic liver disease?
- NSAIDs 2. Corticosteroids
When is the use of eGFR not recommended for dosing? What should be used instead?
- Toxic drugs 2. Elderly 3. Pts at extremes of body mass Creatinine clearance
What is the cockcroft gault equation?
What are the CKD stages based on GFR?
What can phenobarbital affect in infants who breastfeed?
Inhibit infant’s sucking reflex
What can bromocriptine affect in breastfeeding women?
Can affect lactation - inhibits the release of prolactin so decreases milk production
What are the 3 broad classes of analgesics in palliative care?
- Non-opioids - paracetamol, NSAIDs
- Opioids - codiene, weak morphine
- Adjuvants - antidepressants, antiepileptics
