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PRE REG > Clinical Powerpoint > Flashcards

Clinical Powerpoint Flashcards

1
Q

Which drugs increase the anticoagulant effect of warfarin (INR increased\0

A

SSRIs, PPIs, Statins

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2
Q

Which drugs increase the INR by enzyme inhibition

A

erythromycin, miconazole, amiodarone, cimetidine

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3
Q

Which drugs decrease the INR by enzyme induction

A

St John’s wort, carbamazepine, rifampicin, phenytoin

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4
Q

How can antibacterials affect INR

A

Unpredictable but in practice all can effect. Monitor more frequently

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5
Q

Which juice affects INR

A

Cranberry juice - enhances the anticoagulant effect

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6
Q

How does Vitamin K interact with warfarin?

A

Antagonises the effect

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7
Q

How do NSAIDs interact with warfarin?

A

Will not necessarily alter INR but bleed risk is increased significantly. Same for antiplatelets

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8
Q

What are the enzyme INhibitors? (INcrease)

A

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

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9
Q

What are the enzyme inDUCErs? (REDUCE)

A

Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulphonylureas

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10
Q

What is the starting dose for apixaban?

A

Treatment of DVT/PE: 10mg daily for 7 days then 5mg daily
Stroke prophylaxis in AF: 5mg BD or 2.5mg bd in over 80, bw less than 60 or renal impairment

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11
Q

What is the starting dose for rivaroxaban?

A

Treatment of dvt/pe:
15mg bd for 21 days then 20mg daily with food
prophylaxis of dvt/pe recurrent: 10mg daily or 20mg in high risk
af: 20mg daily

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12
Q

What is the starting dose for edoxaban?

A

BW below 60 = 30mg od
BW above 60 = 60mg od

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13
Q

what is the starting dose for dabigatran

A

under 75 - 150mg bd
75-79 - 110-150mg bd
80+ 110mg bd

following 5 days with a parenteral anticoagulant

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14
Q

What is the common interactions with NOACs

A

Increased risk of haemorrhage with NSAIDs, other anticoagulants, antiplatelets, SSRIs, systemic steroids

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15
Q

Which drugs can increase the plasma concentration of NOACs

A

antifungals, diltiazem, verapamil, amiodarone, dronaderone

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16
Q

Which drugs can decrease the plasma conc of NOACs

A

rifampicin, carbamazepine, phenytoin, phenobarbital, st johns wort

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17
Q

What is the antidote for dabigatran

A

idacalizumab

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18
Q

What is the antidote for rivaroxaban/edoxaban/apixaban

A

adenexat alfa

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19
Q

What is the anticoagulant of choice for mechanical heart valves

A

warfarin

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20
Q

Which antiplatelet is indicated for primary prevention and in which cases

A

Aspirin in 10 year risk over 20%
risk vs benefit

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21
Q

which antiplatelet is used as secondary prevention post MI

A

DAPT - dual antiplatelet with aspirin and ticragelor/prasugrel
IF PCI - aspirin and clopidrogel

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22
Q

which antiplatelet is used as secondary prevention post stroke

A

clopidogrel

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23
Q

which antiplatelet is used as secondary prevention post TIA

A

clopidogrel

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24
Q

which antiplatelet is used as secondary prevention in patients with angina

A

Aspirin

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25
which antiplatelet is used as secondary prevention in patients with acs
aspirin + ticragelor/prasugrel
26
which antiplatelet is used as secondary prevention in patients with peripheral arterial disease
clopidogrel
27
which antiplatelet is used as secondary prevention in patients with AF where anticoagulants are unsuitable
DAPT
28
Discuss cv risk assessment
Risk assessment – QRISK – 40 – 74 years every five years – Not if already classed high risk
29
How is cv risk under 10% managed
lifestyle
30
how is cv risk over 10% managed
atorvastatin 20mg, aiming for a 40% reduction in non hdl cholesterol within 3 months
31
Which statin is indicated for secondary prevention
atorvastatin 80mg
32
What are the symptoms of heart failure
breathlesness, fatigue, oedema, orthopnoea
33
What is the lifestyle advice in heart failure
Reduce salt, maintain fluids, smoking, alcohol, exercise
34
Which drugs are used in the tx of heart failure
– ACE inhibitors / BBs – Diuretics (loop/thiazide) – Aldosterone antagonist (spironolactone/eplerenone) – Sacubitril and valsartan – Hydralazine and nitrate (especially for Afro-Caribbean origin) – Digoxin – Ivabradine
35
What are the symptoms of angina and acs
chest pain on exertion (stable) or at rest (unstable)
36
What is the treatment of stable angina
GTN – Beta blocker or CCB – ISMN – Ivabradine – Nicorandil – Ranolazine – Secondary prevention
37
What is the treatment of acute coronary syndromes
Immediate aspirin 300mg stat, GTN and morphine for pain – Unstable angina / NSTEMI – PCI followed by DAPT and secondary prevention (unless low-risk of recurrence) – STEMI – PCI followed by DAPT and secondary prevention
38
When is insulin initiated in t2dm
When dual therapy has not continue to control
39
When are GLP 1's indicated
If triple therapy with metformin and 2 other oral drug sis not effective/tolerated/contraindicated in bmi over 35 or under 35 and insulin would have occupational implications or weight loss would be of benefit
40
In which patient groups is metformin first choice
over weight
41
Which antidiabetic has a lower incidence of weight gain
metformin
42
What are some side effects of metformin
lactic acidosis, b12 deficiency, gi upset
43
What are the risks of SGLT2 inhibitors
dka, uti, thrush, lower limb amputation
44
Which antidiabetic can cause weight gain
sulphonylureas
45
What are the adverse effects of pioglitazone
fluid retention and hospitalisation for cardiac failure fractures in women cv risk bladder cancer risk
46
Discuss GLP1 mimetics
significant weight loss, nausea, care when combining with insulin - reduce insulin dose
47
Which dpp4 is preferred in ckd
linagliptin
48
How can the side effects of nausea and vomitting with erythromycin be managed?
reduced dose of 250mg qds
49
What is used for acute infective exacerbations of COPD
Prednisolone 30mg for 5-7 days and amoxicilin 500mg tds OR doxy 200mg stat then 100mg od for 5-7 days
50
What is used for acute non-infective exacerbations of copd
prednisolone 30mg for 5-7 days
51
What is the first line tx for asthma
ics - saba is only for relief
52
What is the age for duoresp/symbicort inhalers
over 12 if mart regime duoresp/fostair = 18+
53
Which inhalers are more environmentally friendly
dpi - less carbon emissions
54
Which patients require a spacer with a mask
children under 5
55
How often should spacer devices be washed?
once a month
56
How should spacers be cleaned?
warm water and detergent, air dry
57
How often should spacers be replaced
ideally once a year
58
What is the initial step up therapy in children under 5
LTRA as LABA not licensed
59
How is acute asthma managed
Salbutamol - via spacer in community and via nebuliser in hospital prednisolone
60
What is the dose of prednisolone for acute asthma
40-50mg for 5-7 days in adults 10mg in children under 2 20-30 in children 2-5 30-40 in children over 5
61
What are the common SABA inhalers
salbutamol and terbutaline
62
What are the common LABA inhalers
formoterol-salmeterol
63
What are the common LAMAs
Glycopyronium, aclidinium, tiotropium, umeclidinium
64
What are the common LABA/LAMA combos
duakir (aclidinium/formoterol), anoro (umeclidinium/vilanterol)
65
What are the common laba/ics combos
fostair (formoterol/beclometasone), relvar (vilanterol/fluticasone)
66
What is long term use of lithium associated with
thyroid disorders and mild cognitive and memory impairment
67
How often should thyroid function be monitored with lithium
every 6 months at least
68
Is lithium indicated in renal impairment
avoid or monitor carefully - more often if evidence of deterioration or concomitant prescribing of nsaids/ace/diuretics
69
How should lithium be prescribed/dispensed
by brand
70
What is the target serum lithium level
0.4-1mmol/l, 0.8-1 if high risk
71
When is the trough level for litium taken
12 hours post dose
72
What can make lithium toxicity worse
sodium depletion, therefore concurrent use of diuretics particularly thiazides is hazardous
73
What is the most important determinant of dosage for digoxin
renal function
74
Which electrolyte disposes patients to digoxin toxicity
hypokalaemia
75
What is a side effect of theophylline
hypokalaemia
76
How is theophylline metabolised
liver
77
When are theophylline levels increased
heart failure, cirrhosis, viral infections, elderly and by drugs that inhibit its metabolism
78
When are theophylline levels decreased
smokers, alcohol. inducers
79
Discuss the ppp with regards to valproate
Valproate medicines should not be used in women of childbearing potential unless the Pregnancy Prevention Programme is in place * Initially consider whether valproate can be changed to another AED (with specialist input) * Childbearing potential: RCOG recommends PPP for all females that have started their period, otherwise once they reach the age of 13 (unless compelling reasons otherwise) * Women prescribed valproate should be seen by their specialist annually * They should be prescribed highly effective contraception (ie. not user dependent) – IUDs – Implant – Sterilisation * If pills, patches or the injection are used, women must be advised to use additional barrier methods of contraception * Pregnancy should be excluded before starting treatment * Pharmacies need to ensure they discuss risks with patients, including providing appropriate PILs and full boxes where possible * Prescriptions should be limited to a 30-day supply and be dispensed within 7 days (note. not a legal requirement)
80
What is the advice for oral retinoids with regards to pregnancy and breast feeding
Pregnancy * Oral retinoids (eg. Isotretinoid) can cause serious birth defeats * Considering the indication (acne) they are absolutely contraindicated in pregnancy * Women of childbearing potential require a PPP to be in place (similar to valproate) * MHRA advice: * They should be prescribed highly effective contraception (ie. not user dependent) – IUDs, implant, sterilisation * If pills, patches or the injection are used, women must be advised to use additional barrier methods of contraception * Contraception should be continued for one month after stopping treatment * Patients must have a pregnancy test before treatment is started, at intervals (ideally monthly) during and one month after stopping treatment * Prescriptions should be limited to a 30-day supply and be dispensed within 7 days (note. not a legal requirement) * If pregnancy occurs during treatment they must be referred to a specialist for advice Breastfeeding * Retinoids are highly lipophilic and readily pass into breast milk. They are therefore contraindicated in BF §
81
What is the monitoring requirements for methotrexate
FBC, renal and LFTs should be carried out before therapy and repeated weekly until therapy is stabilised, thereafter patients should be monitored every 2-3 months
82
What should patients watch out for with methotrexate
Blood disorders – sore throat, bruising, mouth ulcers * Liver toxicity – nausea, vomiting, abdominal discomfort, dark urine * Pulmonary effects – shortness of breath * Aspirin and other NSAIDs – if aspirin or other NSAIDs are given concurrently the dose of methotrexate should be carefully monitored – avoid OTC
83
Which drugs can cause bone marrow suppression
Carbamazepine * Carbimazole * Chemotherapy * Clozapine * DMARDs * Methotrexate * Phenytoin * Other anti-epileptics
84
Which drugs prolong the QT interval
Can lead to life threatening arrhythmias – Antidepressants – SSRIs, TCA – Antipsychotics – risperidone, haloperidol, quetiapine – Antimicrobials – erythromycin, clarithromycin, fluconazole – Methadone – Domperidone
85
Which drugs can cause serotonin syndrome
Antidepressants – SSRI, TCA, lithium, SJW * Analgesics – tramadol, fentanyl * Antiemetics – ondansetron, metoclopramide
86
What is the tripple whammy for aki
The triple whammy – ACEI, diuretics, NSAIDs
87
Which anti-emetic is used for chemical/metabolic/drug induced vomiting
haloperidol
88
Which anti-emetic is used for gastric stasis
metoclopramide, domperidone
89
Which anti-emetic is used for icp
cyclizine, dex
90
Which anti-emetic is used for motion sickness
cyclizine.cinnarizine
91
Which anti-emetic is used for bowel obstruction
cyclzine
92
Which anti-emetic is used for pain/palliative/agitation
levomeprozamine
93
Which anti-emetic is used for chemo induced
5ht3 antatonist ondansertron

PRE REG (24 decks)

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