Chapter 2- Prescription Review Flashcards

0
Q

Side effects and CI to steroids

A
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection eg. Candida
Diabetes
Syndrome- Cushings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

CI to drugs that increase bleeding eg.aspirin, heparin, warfarin, rivaroxaban

A
  • active or suspected active bleeding
  • risk of bleeding (prolonged PT eg. Liver disease)
  • heparin CI in acute stroke: risk of heamorrhagic transformation
  • enzyme inhibitors eg. Erythromycin increase warfarin effect (increase PT, INR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 categories of SE of anti HTN medications

A
  1. Those of all antiHTN– postural hypotensino
  2. Mechanistic SE:
    B-blockers and rate limiting CCB –> Bradycardia
    ACEi and Diuretics –> Electrolyte disturbances
  3. Those specific to the drug classification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SE of ACEi (3)

A
  1. Dry cough (increased bradykinin as no ACE to metabolise it)
  2. Hyperkalaemia (Reduced aldosterone, therefore reduced excretion of K+)
  3. Acute renal failure (reduced ANGII so no efferent arteriole constriction if GFR reduces)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SE of B-blockers (3)

A
  1. Bradycardia
  2. Wheeze (brittle asthma)
  3. worsens acute heart failure (cf. Rx in chronic HF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SE of CCBs (2)

A
  1. Peripheral oedema

2. flushing

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

SE of diuretics:

  1. All diuretics
  2. K sparing Diuretics
  3. Loop diuretics
A
  1. renal failure due to hypoperfusion of the kidney
  2. eg. frusemide: GOUT
  3. eg. Spironolactone: Gynaecomastia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antihypertensives causing Hypokalaemia

A

Loop Diuretics: Frusemide

Thiazides:

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

Antihypertensives causing Hyperkalaemia

A

K sparing diuretics: Spironolactone

ACEi: Perindopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ACEi- HTN

A

To be used in younger patients (<55years) with HTN (A)
Should not be used in Afro-caribbean pts (angioedema).
Highly indicated for HTN + DM nephropathy
Must stop K supps and K sparing diuretics before use.

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

ACEi- heart failure

A

Used in acute and chronic HF
Must stop K supps and K sparing diuretics before use.
In pts with HF who are on loop diuretics, can cause first dose hypotension. STOP loops to prevent this. BUT… increased risk of REBOUND PULMONARY OEDEMA.

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

Renal Effects of ACEi

A
  • Check U&E, Cr before starting
  • hyperK more common in renal impairment (and if on K sparing diuretics)
  • NSAID + ACEi increases risk of renal damamge
  • CI: bilateral RAS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Names of ACEi

A

Capatopril
Enalapril
Lisinopril
Perindopril

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

Names of ARBs

A

ANG II-R-ANT
Candesartan
Irbesartan

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

Fluid depletion- clincial examination –> approximation

A

500ml depletion = Oliguria (<30ml/hr or anuria)
1L depletion = OLiguria + tachicardia
2L depletion + Oliguria + shock

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

Fluid replacement in a tachycardic/hypotensive patient

A

500ml Bolus
1L if Young and fit
250ml if in heart failure

reassess

16
Q

Fluid replacement in an oliguric (and non obstructed patient)

A

1L over 2-4 hours –> reassess.

17
Q

Maintenance fluids of an adult (non elderly)

  • total volume
  • Prescription to give adequate electrolytes
A
  • total volume = 3L/24hours –> 8 hourly bags
  • 1L NaCl + 2L 5% Dexrose / 24 hours (if not eating)
  • K+ supplementation: 40mmol/L/day –> 20mmol KCl in 2 bags of fluid.
  • Plasmalyte- compound sodium acetate
  • Hartmanns contains K and lactate
18
Q

Signs of Fluid Overload

A
  • raised JVP
  • Peripheral oedema
  • Pulmomary oedema
19
Q

Blood Clot prophylaxis

A

LMWH and TED stockings

20
Q

CI to LMWH

A
  • bleeding or risk of bleeding

- recent ischaemic stroke (haemorrhagic transformation risk)

21
Q

CI to TED stockings

A

peripheral arterial disease (absent foot pulses) –> risk of acute limb ischaemia (6Ps)

22
Q

Antiemetics: mechanisms of action

A

H1-ANT: Cyclizine
DA2-ANT: Metoclopramide, Domperidone
DA-ANT: Phenothiazines- block chemo-R trigger zone: Prochlorperazine
5HT3-ANT: Ondansetron

23
Q

Cyclizine

A

H1 ANT
Good first line anti emetic EXCEPT IN HEART FAILURE (SE: fluid retention)
50mg 8hourly (PO/IV/IM)

24
Metoclopramide
DA2-ANT Can be used in heart failure 8hourly IV/IM AVOID: 1. Parkinsons 2. Young Women --> acute dystonic reactions (oculogyric crisis)
25
Domperidone
DA2-ANT | CAN be used in PARKINSONS: doesnt cross BBB
26
Maximum daily dose Paracetamol
1g upto 6hourly (Max 4g in 24hours)
27
Maximum Codeine daily
30mg up to 6hourly (120mg in 24 hours)
28
Maximum Morphine daily
10mg up to 6hourly (40mg daily) | Caution in Oramorph: 10mg/5ml and 5mg/5ml
29
Analgesia in neuropathic pain
First line: Amitryptilline, PreGABAlin | Painful diabetic neuropathy: Duloxetine
30
Giving Methotrexate and Trimethoprim (or any other folate ANT) is CI becasue it can cause.....
PANCYTOPENIA
31
If a patient is on Methotrexate and develops sepsis....
STOP METHOTREXATE IMMEDIATELY until you have excluded neutropenic sepsis
32
breakthrough dose of opiates
1/6 of daily morphine dose. | eg. pts usual dose is 30mg BD, so break through dose is 1/6 of 60mg = 10mg
33
should also prescribe this when pt receiving opioids
laxative
34
Opioids in CKD...
Alfentanil Buprenorphine Fentanyl preferred
35
Pain relief in metastatic bone pain
NSAIDS Bisphosphonates RT
36
Conversion from codeine to morphine
divide by 10
37
conversion from tramadol to oral morphine
divide by 10