commonly prescribed drugs pt 3

Question 1

what is Etoricoxib?

Answer 1

it is a COX 2 inhibitor

Question 2

what are the safety concerns around etoricoxib?

Answer 2

there are GI and renal safety concerns with all NSAIDs
increased risk of CV events

Question 3

what NSAID has the most favourable thrombotic safety profile ?

Answer 3

naproxen

Question 4

what is the general prescribing points surrounding NSAIDs?

Answer 4

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

Question 5

how do NSAIDs interfere with renal function?

Answer 5

NSAIDs may precipitate renal failure and people at risk of renal failure/ impairment must avoid

Question 6

what triple therapy should be avoided with renal problems?

Answer 6

use of triple therapy consisting of a diuretic + ACEi or and ARB along with an NSAID is associated with increased rate of AKI

Question 7

who should etoricocib not be prescribed for?

Answer 7

people whos blood pressure is persistently above 140/90mmHg and inadequately controlled

Question 8

what is ferrous sulphate for?

Answer 8

iron deficiency anaemia

Question 9

what should the risk in Hb be when given ferrous sulphate?

Answer 9

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

Question 10

what are some of the side effects of ferrous sulphate?

Answer 10

• GI irritation common
• Constipation, particularly in the elderly
  Important cause of accidental overdose in children CAUTION

Question 11

what is finasteride used for?

Answer 11

• Benign prostatic hyperplasia
• This leads to reduction in prostate size, with improvement in urinary flow rate

Question 12

what warning did the MHRA give about finasteride?

Answer 12

MHRA/CHM advice: rare reports of depression and suicidal thoughts
immediately inform a HCP if they develop this

Question 13

what should be taken into account regarding fertility/ protection with finasteride?

Answer 13

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.

Question 14

what should men report with finasteride?

Answer 14

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

Question 15

what is furosemide? what is their MOA?

Answer 15

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

Question 16

what onset of action does furosemide have?

Answer 16

rapid onset of action:
IV- 5 min
orally-1-2 hours
duration of action- 4-6 hours

Question 17

what should patients receiving loop diuretics be monitored for?

Answer 17

electrolyte abnormalities

Question 18

when should you potentially stop inappropriate furosemide in older people?

Answer 18

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)

Question 19

what electrolyte imbalance can occur with diuretics?

Answer 19

• 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

Question 20

when can urinary retention occur with loop diuretics?

Answer 20

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

Question 21

what is gabapentin used for?

Answer 21

A range of indications including seizures and
neuropathic pain

Question 22

how is gabapentin initiated?

Answer 22

titrated gradually

Question 23

how does neuropathic pain occur?

Answer 23

occurs as a result of damage to
neural tissue

Question 24

what safety concerns is there regarding gabapentin?

Answer 24

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

Question 25

where is gabapentin stored?

Answer 25

reclassified as class C Controlled substance now a CD 3 drug but is exempt from safe custody requirements