commonly prescribed drugs part 4

Question 1

what is methotrexate/ what is it used for?

Answer 1

Disease modifying anti-rheumatic drug
(DMARD)

Question 2

what toxicities are associated with methotrexate?

Answer 2

blood, liver, pulmonary

Question 3

how is methotrexate excreted?

Answer 3

renally

Question 4

how should methotrexate be given?

Answer 4

once weekly dose
folic acid on alt days

Question 5

what is metoclopramide? how does it act?

Answer 5

• Anti-emetic
• Acts directly on the GI tract

Question 6

what can metoclopramide induce?

Answer 6

Can induce dystonic reactions involving facial
and skeletal muscle spasms and oculogyric
crises

Question 7

what are the known risk of metoclopramide?

Answer 7

neurological effects such as short-term
extrapyramidal disorders and tardive dyskinesia

Question 8

who can metoclopramide be used in?

Answer 8

In adults over 18 years, metoclopramide should only be used for prevention of postoperative nausea and vomiting, radiotherapy-induced nausea and vomiting, delayed (but not acute) chemotherapy-induced nausea and vomiting, and symptomatic treatment of nausea and vomiting, including that associated with acute migraine (where it may also be used to improve absorption of oral analgesics)

Question 9

how long can you use metoclopramide for?

Answer 9

• Metoclopramide should only be prescribed for short-term use (up to 5 days)

Question 10

what is the usual dose of metoclopramide?

Answer 10

Usual dose is 10 mg, repeated up to 3 times daily; max. daily dose is 500 micrograms/kg;

Question 11

what is metronidazole?

Answer 11

Anti-microbial with a high activity against anaerobic bacteria
* Metronidazole is an antibiotic that may produce unpleasant side effects when taken with alcohol

Question 12

what are the effects that can be produced when metronidazole is combined with alcohol?

Answer 12

– flushing,
* – feeling sick,
* – vomiting,
* – headache,
* – dizziness, and
* – palpitations

Question 13

how long should alcohol be avoided for after metronidazole?

Answer 13

avoid alcohol for 48 hours after

Question 14

when should you avoid the use of nitrofuratoin?

Answer 14

Adults – avoid if eGFR less than 45ml/min/1.73m2
– Use with caution with eGFR between 30 and
44ml/min/1.73m2 to treat uncomplicated lower
urinary tract infection caused by suspected or
proven multidrug resistant bacteria and only if
benefit outweighs risk

Question 15

what is quinine sulphate generally used for?

Answer 15

treatment of leg cramps

Question 16

what adverse reactions can occur with quinine sulphate?

Answer 16

tinnitus, impaired hearing, headache, nausea, disturbed vision, confusion, flushing, and abdominal pain. Treatment should be
stopped if these occur.

Question 17

what should be done if there is a thrombocytopenia reaction to quinine sulphate?

Answer 17

Patients should be instructed to stop treatment and consult a physician if signs of thrombocytopenia occur, such as unexplained petechiae, bruising, or bleeding.

Question 18

what are the signifigant drug interactions with quinine sulphate?

Answer 18

digoxin and warfarin. It also has significant toxicity in overdose, which can result in death or permanent visual loss

Question 19

when should quinine sulphate be used for leg cramps?

Answer 19

should only be used when cramps regularly disrupt sleep

Question 20

when should quinine sulphate be revewed for leg cramps?

Answer 20

After a trial of at least 4 weeks, treatment should be stopped if there is no benefit. If treatment continues, the benefits should be assessed around every 3 months

Question 21

who should not be treated with tramadol?

Answer 21

Patients with a history of epilepsy or those
susceptible to seizures should only be treated
with tramadol if there are compelling reasons.
* Tramadol should be used with caution in patients taking medication that can lower the seizure threshold, particularly selective serotonin reuptake inhibitors and tricyclic antidepressants.

Question 22

what is trimethoprim

Answer 22

it is an anti-folate used to treat UTIs

Question 23

what are the problems associated with trimethoprim?

Answer 23

• Teratogenic
• Interactions (several significant – check BNF)
  examples:
  – ACE + Trimethoprim = increased risk of
  hyperkalaemia
  – Methotrexate = Trimethoprim = increased risk of haematological toxicity