*Chapter 9 Qs Flashcards

1
Q

ACEi: ADR

A

ACE-i can cause renal impairment, so measure serum creatinine before any dose titration. Also causes hyperkalaemia + hyponatraemia – but checking K+ more important as abnormalities can cause fatal arrhythmias.

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2
Q

Beta-blockers: ADR

A
  • Beta-blockers cause fatigue*
  • – do not cause heat intolerance (actually cold extremities), tremor (actually treat essential + anxiety-related tremor), HTN (actually more likely to cause hypotension), tachycardia (actually bradycardia).*
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3
Q

Naproxen:ADR

A
  • Naproxen is an NSAID – inhibits prostaglandin synthesis needed for gastric mucosal protection from acid – so increases risk of GI inflammation + ulceration.*
  • Corticosteroids inhibit gastric epithelial renewal, thus predisposing to ulceration.*
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4
Q

Diclofenac:ADR

A
  • Diclofenac + another NSAIDs can → AKI, by affecting renal haemodynamics or via acute interstitial nephritis (more likely if pre-existing renal impairment).*
  • ACE-i + NSAID shouldn’t be co-prescribed. ACE-i relax efferent blood vessels (eFF off i.e. leave kidney) while NSAIDs relax afferent vessels = excessive pressure drop.*
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5
Q

Methotrexate and ?WHAT ABX may result in an ADR

A

Trimethoprim = folate antagonist, like methorexate. Never give together as additive toxicity risk = BM suppression, pancytopenia + neutropenic sepsis.

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6
Q

Amiloride: ADR

A

Amiloride = K+ sparing diuretic. ACE-i + K+ sparing diuretic = potential hyperkalaemia, so monitor electrolytes regularly, especially after dose changes.

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7
Q

Warfarin and ?WHAT ABX may result in an ADR

A
  • All antibiotics listed here potentially interact with warfarin – but potentially serious interaction indicated in BNF by black dot – this is erythromycin.*
  • NB: Augmentin = Co-amoxiclav.*
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8
Q

What to do with a pt on warfarin and an INR > 8

A

INR over 8 + haematuria = stop warfarin, give vitamin K by slow IV injection

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9
Q

Steps in Management Anaphylactic shock due to a drug e.g co-amoxiclav

A

Stop the insult

ABCDE: throat swelling-> secure airway first.

IM adrenaline (not beneficial without patent airway.)

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10
Q

Management of drug induced hypoglycaemia

A
  • Hypoglycaemia.*
  • Conscious patient = 10-20g glucose by mouth.*
  • Unconscious = glucose IV 20% (not 50% as extravasation injury + viscous).*
  • Drug-induced hypoglycaemia must be managed in hospital as hypoglycaemic effects can persist for many hours.*
  • IM/IV/SC glucagon usually for unconscious patient where no IV access.*
  • Metformin less likely to cause hypoglycaemia than sulphonylyureas.*
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