CLIVIA STUFF

Question 1

What are the triple whammy drugs?

Answer 1

ACEI/ARBs, NSAIDs, diuretics

Question 2

What are the possible dangers of taking triple whammy drugs concurrently?

Answer 2

Increased risk of AKI

Question 3

Name at least 5 drugs that may improve mortality in HF

Answer 3

Cardevilol
Metoprolol succinate
Bisoprolol 
Spironolactone
ACE inhibitors

Question 4

Why is GTN given sublingually?

Answer 4

GTN undergoes significant first-pass metabolism when given orally

Question 5

Can spironolactone or eplerenone be given in pregnancy?

Answer 5

Spironolactone: NO (Cat D)
Eplerenone: YES (Cat B)

Question 6

List the PQRSTU of pain management

Answer 6

P - Provocative, palliative
Q - Quality, quantity
R - Region, radiation
S - Severity
T - Timing, treatment
U - Understanding

Question 7

State the MOA of ACE inhibitors

Answer 7

ACE inhibitors inhibit the action Angiotensin-Converting Enzyme, subsequently inhibiting the conversion of Angiotensin I to Angiotensin II.

Angiotensin II constricts the efferent arterioles at the glomerulus. When inhibited, the increase in efferent tone increases/ stabilises the intraglomerular pressure. This maintains or increases the GFR.

Question 8

What is the dose of paracetamol for children <12 y/o?

Answer 8

10-15 mg/kg/dose

Question 9

Which classes of drugs should not be taken concurrently with DXM?

Answer 9

1. Antidepressants
   - SSRIs
   - SNRIs
   - TCAs
   - MAOIs
   - Others (bupropion, trazodone, mirtazipine)
2. Analgesics
3. Antibiotics
4. Triptans
5. Antiemetics
6. Herbals (e.g. St John’s wort)
7. Dopamine agonists

Question 10

How do NSAIDs potentially increase the risk of AKI?

Answer 10

NSAIDs inhibit the conversion or arachidonic acid to prostaglandin, thereby inhibiting PG-mediated afferent vasodilation. This causes vasoconstriction of the afferent renal arteriole, which reduces the ability of the kidney to regulate (increase) glomerular blood flow

Question 11

What are the black box warnings for NSAIDs?

Answer 11

1. CV: “NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.”
2. GI: “NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events.”

Question 12

Can NSAIDs be taken during pregnancy?

Answer 12

NSAIDs should be avoided during pregnancy.

NSAIDs may cause premature closure of the ductus arteriosus in the foetus when taken in the 3rd trimester