Common drug SEs etc Flashcards
How do you monitor furosemide efficacy?
Weight daily
What blood to monitor furosemide?
U+Es (hypokal)
If oral furosemide isn’t working what can you try?
IV better bioavailability
If furosemide is given BD what timings?
morn and lunch (at night- nocturia)
Do you worry about first dose hypotension in diuretics?
Not so much
When in the day should you give nitrates?
morn and lunch- need a nitrate free period as get tolerance
When should you give first dose of ramipril?
Night (first dose hypotension)
Monitoring bloods for ACEi?
U&Es and LFTs (pro drug so needs good liver function)
Does someone need to omit ACEi if D&V
Yes possibly- sick day rules- to call doc
Timings of parkinsons meds?
Same time each day
What if parkinson medicated pt is NBM?
Convert to rotigotine patch (use website)
When should you take statins? why
Night as that is when the enzyme works
Which statin does timing not matter in?
Atorvostatin
Any action need to be taken if someone on statin is given amlodipine?
Reduce dose of statin
What drink should statin patients avoid?
Grapefruit juice
Counselling re SEs for statin?
Rhabdomyolysis
Common metformin SE?
GI
Why is metformin MR?
So plasma drug level stable for SEs
What if metformin patient has decline in eGFR?
Stop the metformin and monitor BMs
Digoxin + hypokalaemia =?
risk toxicity
If converting digoxin or phenytoin from tablet to liquid form what needs to be done
reduce dose
Vancomycin loading dose is based on?
weight
Vancomycin maintenance dose is based on?
Creatinine clearance
Methotrexate patients should avoid which drugs? why?
NSAIDs and penicillins as they reduce clearance of MTX
How is MTX given?
Weekly with folic acid on the other days
When do you give a reduced dose of paracet?
Pt <45kg (max dose is 15mg/kg)
How do you give paracet in liver impairment?
max 3g/day
What does the number mean in an insulin name e.g. humalog mix 25
The amount of short acting in it
Do they still need long acting insulin if on a sliding scale?
Yes but at 80% dose
What insulin will the sliding scale be?
Actrapid
What is the route of insulins? Except?
All SC except fast acting in a sliding scale (Actrapid/novorapid) which are IVI
Are oral antibiotics ever used in neut sepsis?
No not enough- IV probably tazocin and gent
Which antiemetic is fine to use in parkinsons as it doesn’t cross the BBB?
Domperidone
What must always be tried before giving IV GTN in ACS?
Sublingual
Name three LMW heparins
Enoxaparin, tinzaparin, dalteparin
Can ACEi be used in pregnancy?
No - labetalol instead
Do sulfonylureas carry a risk of hypoglycaemia?
Yes
What do you need to test before starting a statin?
ALT
What drug is given in acute dystonic reaction to antipsychotics? When is it NOT given?
procyclidine
Tardive dyskinesia
Which antihypertensives are contraindicated in PVD?
β blockers can cause peripheral vasoconstriction and worsen ischaemia in PVD
ACEi cautioned in severe
What can’t you use verapamil with?
beta blockers (bradycardia)
Can you give CCBs in heart failure?
Should avoid except amlodipine
What drug can increase risk of rhabdo on a statin?
Gemfibrozil
What route might be avoided in anticoagulated pt?
IM
What do you do if statin causes Cr to be 5x normal range?
Stop it and if symptoms resolve re-start and lower dose
