commonly prescribed drugs pt 3 Flashcards
what is Etoricoxib?
it is a COX 2 inhibitor
what are the safety concerns around etoricoxib?
there are GI and renal safety concerns with all NSAIDs
increased risk of CV events
what NSAID has the most favourable thrombotic safety profile ?
naproxen
what is the general prescribing points surrounding NSAIDs?
based on individual assessment- individual risk factors- CV and GI illnesses?
the lowest effective dose should be used for the shortest duration necessary to control a persons symptoms
how do NSAIDs interfere with renal function?
NSAIDs may precipitate renal failure and people at risk of renal failure/ impairment must avoid
what triple therapy should be avoided with renal problems?
use of triple therapy consisting of a diuretic + ACEi or and ARB along with an NSAID is associated with increased rate of AKI
who should etoricocib not be prescribed for?
people whos blood pressure is persistently above 140/90mmHg and inadequately controlled
what is ferrous sulphate for?
iron deficiency anaemia
what should the risk in Hb be when given ferrous sulphate?
Hb concentration should rise by about 2g/100ml over 3-4 weeks
When Hb is in normal range, treatment should
continue for a further 3 months to replenish the iron stores
what are some of the side effects of ferrous sulphate?
- GI irritation common
- Constipation, particularly in the elderly
Important cause of accidental overdose in children CAUTION
what is finasteride used for?
- Benign prostatic hyperplasia
- This leads to reduction in prostate size, with improvement in urinary flow rate
what warning did the MHRA give about finasteride?
MHRA/CHM advice: rare reports of depression and suicidal thoughts
immediately inform a HCP if they develop this
what should be taken into account regarding fertility/ protection with finasteride?
Finasteride is excreted in semen and use of a
condom is recommended if sexual partner is
pregnant or likely to become pregnant.
* Women of childbearing potential should avoid
handling crushed or broken tablets of
finasteride.
what should men report with finasteride?
Cases of male breast cancer have been
reported. Patients or their carers should be told
to promptly report to their doctor any changes
in breast tissue such as lumps, pain, or nipple
discharge
what is furosemide? what is their MOA?
loop diuretic- have powerful diuretic action, increasing the excretion of sodium and water via their action on the ascending limb of the loop of henle
what onset of action does furosemide have?
rapid onset of action:
IV- 5 min
orally-1-2 hours
duration of action- 4-6 hours
what should patients receiving loop diuretics be monitored for?
electrolyte abnormalities
when should you potentially stop inappropriate furosemide in older people?
as a first-line treatment for hypertension (safer, more effective alternatives available)
* for treatment of hypertension with concurrent
urinary incontinence (may exacerbate
incontinence)
* for dependent ankle oedema without evidence of heart failure, liver failure, nephrotic syndrome or renal failure (leg elevation and/or compression
hosiery usually more appropriate)
what electrolyte imbalance can occur with diuretics?
- Hypokalaemia can occur with loop
diuretics - Hypokalaemia is dangerous in severe
cardiovascular disease and in patients also
being treated with cardiac glycosides.
Often the use of potassium-sparing
diuretics avoids the need to take
potassium supplements
when can urinary retention occur with loop diuretics?
If there is an enlarged prostate, urinary
retention can occur, although this is less
likely if small doses and less potent
diuretics are used initially; manufacturer
advises adequate urinary output should be
established before initiating treatment
what is gabapentin used for?
A range of indications including seizures and
neuropathic pain
how is gabapentin initiated?
titrated gradually
how does neuropathic pain occur?
occurs as a result of damage to
neural tissue
what safety concerns is there regarding gabapentin?
rare risk of severe respiratory depression even without concomitant opioid medicines.
Patients with compromised respiratory function, respiratory or neurological disease, renal impairment, concomitant use of central nervous system (CNS) depressants, and elderly people might be at higher risk of experiencing severe respiratory depression and dose adjustments may be necessary in these patients
where is gabapentin stored?
reclassified as class C Controlled substance now a CD 3 drug but is exempt from safe custody requirements
