BNF Preliminary Chapters Flashcards
How does Hepatic impairment affect the human body?
Impaired metabolism (reduced metabolism) Hypoproteinaemia (low albumin) High INR, prothrombin Malabsorption of fat soluble vitamins Reduced bile excretion
What drugs are affected by hypoproteinaemia ?
NSAIDS
Warfarin
Phenytoin
Prednisolone
Which drugs can cause hepatic encephalopathy in severe liver disease?
Constipation: codeine, TCAs
Sedatives : antihistamines, Benzos, opioid
Hypokaelimic: diuretics
Which drugs are capable of causing oedema and ascites?
CCB
NSAIDs
Steroids
What are the signs and symptoms of hepatotoxicity?
Weight loss Abdominal pain N and V Dark urine Jaundice Itching Pale stools
Which drugs are enzyme inhibitors ?
Sodium Valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole Alcohol Chloramphenicol Erythromycin Sulphonamide
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit
Which drugs are enzyme inducers?
Carbamazepine
St. John’s worst
Barbituates
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitals
Sulfonylurea
Which drugs interact with grapefruit juice?
CNS: Quetiapine, setraline
CVS: Amiodarone , CCB
Immunosuppressants: tacrolimus, ciclosporin
Other: PDE5 inhibitors , colchicine
What liver results would you expect in hepatic impairment m?
High ALT High AST High ALP High GGT High bilirubin (jaundice) Low albumin High Prothrombin INR (low clotting factors)
What are the effects of renal impairment?
Reduced excretion (barrow therapeutics)
Reduced renal clearance
More sensitive to nephrotoxicity
What are the signs and symptoms of acute kidney injury?
Dehydration Reduced urine High BP Oedema Confusion Fatigue
What are the sick day rules and what is the reasoning behind them?
Dehydration is a major risk factor for AKI?
When N and V stop these:
Diuretics
ACE / ARB
Metformin
NSAIDs
When can DAMN drugs be restarted after sick day rulesv
24/48 hrs after normal eating
Which drug change urine colour to:
RED BLUE ORANGE YELLOW BROWN PINK/ORANGE
RED: co-danthramer, levodopa, doxorubicin, idebenone
BLUE: Triamterene
ORANGE: Rifampicin , sulfalazine l
YELLO: nitrofurantoin, senna
BROWN : prostaglandin analogues
Pink: phenidions
What strength morphine solution is CD5?
Below 13mg/5ml
When does breakthrough pain become an issue and pain management have to be reviewed?
If taking medicine for breakthrough pain twice daily or more
Between morphine and diamorphine, which is prefered parenterally due to increased solubility?
Diamorphine
What’s the dose conversion from oral morphine to parenteral morphine and diamorphine?
Morphine : 1/2
Diamorphine: 1/3
What’s the dose reduction when switching morphine to transdermal DUE TO HYPERALGESIA
25-50%