commonly prescribed drugs part 4 Flashcards
what is methotrexate/ what is it used for?
Disease modifying anti-rheumatic drug
(DMARD)
what toxicities are associated with methotrexate?
blood, liver, pulmonary
how is methotrexate excreted?
renally
how should methotrexate be given?
once weekly dose
folic acid on alt days
what is metoclopramide? how does it act?
- Anti-emetic
- Acts directly on the GI tract
what can metoclopramide induce?
Can induce dystonic reactions involving facial
and skeletal muscle spasms and oculogyric
crises
what are the known risk of metoclopramide?
neurological effects such as short-term
extrapyramidal disorders and tardive dyskinesia
who can metoclopramide be used in?
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)
how long can you use metoclopramide for?
- Metoclopramide should only be prescribed for short-term use (up to 5 days)
what is the usual dose of metoclopramide?
Usual dose is 10 mg, repeated up to 3 times daily; max. daily dose is 500 micrograms/kg;
what is metronidazole?
Anti-microbial with a high activity against anaerobic bacteria
* Metronidazole is an antibiotic that may produce unpleasant side effects when taken with alcohol
what are the effects that can be produced when metronidazole is combined with alcohol?
– flushing,
* – feeling sick,
* – vomiting,
* – headache,
* – dizziness, and
* – palpitations
how long should alcohol be avoided for after metronidazole?
avoid alcohol for 48 hours after
when should you avoid the use of nitrofuratoin?
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
what is quinine sulphate generally used for?
treatment of leg cramps
what adverse reactions can occur with quinine sulphate?
tinnitus, impaired hearing, headache, nausea, disturbed vision, confusion, flushing, and abdominal pain. Treatment should be
stopped if these occur.
what should be done if there is a thrombocytopenia reaction to quinine sulphate?
Patients should be instructed to stop treatment and consult a physician if signs of thrombocytopenia occur, such as unexplained petechiae, bruising, or bleeding.
what are the signifigant drug interactions with quinine sulphate?
digoxin and warfarin. It also has significant toxicity in overdose, which can result in death or permanent visual loss
when should quinine sulphate be used for leg cramps?
should only be used when cramps regularly disrupt sleep
when should quinine sulphate be revewed for leg cramps?
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
who should not be treated with tramadol?
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.
what is trimethoprim
it is an anti-folate used to treat UTIs
what are the problems associated with trimethoprim?
- Teratogenic
- Interactions (several significant – check BNF)
examples:
– ACE + Trimethoprim = increased risk of
hyperkalaemia
– Methotrexate = Trimethoprim = increased risk of haematological toxicity
